Assessment of the increased calcification of the jaw bone with CT-Scan after dental implant placement

Effect of calcium and Vitamin D supplementation on residual ridge resorption in edentulous patients: An open-label randomized study

AIM

Complete dentures (CDs) are fabricated to rehabilitate the edentulous. Severe residual ridge resorption (RRR) compromises CD functionality, adversely affecting function, appearance, systemic health, and quality of life.

SETTINGS AND DESIGN

The purpose of this study was to assess the benefit, if any, of calcium and Vitamin D supplementation on the rate of RRR. Retarding RRR would improve treatment prognosis and make CD fabrication less demanding.

MATERIALS AND METHODS

This longitudinal, parallel, open-label randomized study was conducted in the Department of Prosthodontics of the institute. One hundred and fifty edentulous subjects underwent bone mineral density (BMD) assessment followed by CD fabrication to measure RR height and width with computerized tomographic (CT) scans. Subjects were randomized to oral supplementation group - S, given combined Vitamin D and calcium daily, and nonsupplementation group - NS. Subjects from both the groups were followed up with repeat BMD test and CT scan after 12 months. Mean BMD, RR height and width, and RRR values were collected, analyzed, and compared for the two groups using STATA 17.

STATISTICAL ANALYSIS USED AND RESULTS

Baseline mean T-score, RR height, and RR width were - 1.84, 22.30 mm, and 4.25 mm, respectively, for the sample. In both Groups S and NS, a statistically significant decrease in mandibular RR height (P = 0.000 for both) and width (P = 0.027 and 0.003, respectively) was observed at 1-year follow-up. There was a statistically insignificant difference between Groups S and NS for mean BMD, T-score, RR height and width, and RRR at both baseline and 12-month follow-up. One-year RRR rate for Group S (1.30 mm) was insignificantly lesser than for group NS (1.33 mm).

CONCLUSION

Short-term oral calcium and Vitamin D supplementation was ineffective in reducing RRR and improving BMD.

The Influence of Low-Level Laser Therapy on CBCT Radiographic and Biochemical Profiles of Type II Controlled Diabetic Patients After Dental Implant Insertion: A Randomized Case-Control Study

Background Low-level laser treatment (LLLT) was thought to increase bone quality during osseointegration when combined with dental implants. However, there is no sufficient information on its impact on dental implants in diabetics. Osteoprotegerin (OPG) has been described as a marker for bone turnover to determine implant prognosis. The current research aims to evaluate the effect of low-level laser therapy (LLLT) on bone density (BD) and osteoprotegerin levels in peri-implant crevicular fluid (PICF) in type II diabetic patients. Methods This study comprised 40 individuals with type II diabetes mellitus (T2DM). Implants were randomly placed in 20 non-lasered T2DM patients (control) and 20 lasered T2DM patients (LLLT group). At the follow-up stages, BD and OPG levels in the PICF were evaluated in both groups. Results Significant variations were shown among control and LLLT groups concerning OPG level and BD (p≤0.001). OPG was significantly decreasing with follow-up points (p≤0.001). There was a significant decrease in OPG with time in both groups with a higher decrease in the control group. Conclusion LLLT is promising in controlled T2DM patients due to its outstanding influence on BD and estimated crevicular levels of OPG. Regarding its clinical significance, LLLT significantly improved bone quality during osseointegration on dental implants in T2DM. LLLT is considered potentially important for T2DM patients during implant placement. Trial registration The study was registered on ClinicalTrial.gov under registration number NCT05279911 (registration date: March 15, 2022) (https://clinicaltrials.gov/ct2/show/NCT05279911).

Evaluation of immediately loaded mandibular four vertical versus tilted posterior implants supporting fixed detachable restorations without versus with posterior cantilevers

BACKGROUND

Distally inclining posterior implants may be technically challenging in certain situations. The presence of a posterior cantilever can also exert unfavorable forces on supporting implants. The aim of the present study was to evaluate and compare peri-implant soft and hard tissues around 4 mandibular interforaminal implants having tilted posterior implants with posterior cantilevers, versus vertical implants, 2 in the interforaminal region and 2 in the first molar regions, without posterior cantilevers. All implants supported full-arch fixed detachable restorations opposing complete dentures.

MATERIAL AND METHODS

A total of 80 implants were placed flapless in the mandibles of 20 edentulous participants. Four implants were placed for every participant, who were randomly assigned into 2 equal groups. Axial group implants were vertically aligned, with 2 implants in the interforaminal area and 2 in the molar area. Tilted group implants have 2 anterior axial and 2 posterior distally inclined implants. Interim screw-retained prostheses converted from pre-existing dentures were immediately fabricated and loaded on the same day of surgery. After awaiting period of 3 months, all participants received fixed detachable metal acrylic resin definitive restorations. A follow-up protocol of 3, 6, and 12 months was scheduled to assess the modified gingival index, modified plaque index, peri-implant probing depth, implant stability, and marginal bone level and bone density changes.

RESULTS

No statistically significant differences (P > .05) were found in the modified gingival index, modified plaque index, peri-implant probing depth, implant stability, bone density, and marginal bone level between the axial and tilted implant groups after the 1-year follow-up period.

CONCLUSION

Placing 4 flapless immediately loaded implants in mandibular edentulous patients that supported full-arch fixed restorations provided high implant and prosthodontic success rates whether posterior implants were tilted with posterior cantilevers or vertically aligned without posterior cantilevers.

TRIAL REGISTRATION

Pan African Clinical Trial Registry database, PACTR201907776166846. Registered 3 July 2019, www.pactr.org .

Effect of Implant Surface Modification on Bone Mineral Density and Survival Rate in the Maxilla After a Short Period Using Cone Beam Computed Tomography

ABSTRACT

This study was aimed to objectively measure the changes in bone density amount obtained through cone-beam computed tomography around dental implants after a short period of time in the maxilla. Thirty-two SLActive Straumann implants were inserted into 12 healthy patients. Changes in bone density were measured at the surgery time (Bone mineral density (BMD)0) and 60 days after investment (Bone mineral density (BMD)60). Statistically, significant differences were observed between traumatic and sinus zones at the time of surgery and after 60 days respectively (P ≤ 0.05). For each group, a significant decrease in density was observed with the following variables (male, age of 18-40 years, sinus zone, and implant diameter of 4.1 mm). The survival rate was 83.8% after 60 days. Implant surface modification has no significant effect on bone mineral density after a short period of time in the sinus zone. Early loading of the prosthesis can be performed in the traumatic zone only.

Clinical and radiographic evaluation of implants placed with fully guided versus partially guided tissue-supported surgical guides: A split-mouth clinical study

STATEMENT OF PROBLEM

The effect of placing implants by using a fully guided protocol versus a partially guided protocol on the peri-implant soft and hard tissues is unclear. C-shaped guide holes are often used; however, their effect on drilling and peri-implant tissues has not been thoroughly investigated.

PURPOSE

The purpose of this split-mouth clinical study was to clinically and radiographically evaluate peri-implant soft and hard tissues after implant placement by using fully guided versus partially guided surgical guides with cylindrical versus C-shaped guide holes.

MATERIAL AND METHODS

Adopting an 80% power of the study in calculating sample size, a total of 48 implants were placed in the mandibular interforaminal area of 12 edentulous participants. Implants were randomly divided into 2 groups: a fully guided group comprising 24 implants placed on 1 side by using a fully guided protocol and a partially guided group comprising 24 implants placed on the other side of the same participant by using a partially guided protocol. Each group was further subdivided into 2 subgroups: cylindrical, including 12 implants placed through cylindrical guide holes, and C-shaped (12 implants) placed through C-shaped guide holes. All participants were clinically evaluated in terms of a modified plaque index, modified gingival index, peri-implant probing depth, and probing attachment level at 2, 4, and 6 months. Implant stability, marginal bone level, and bone density were then evaluated immediately after implant placement at 2, 4, and 6 months.

RESULTS

No statistically significant differences were found in the plaque index (P=.927), modified gingival index (P=.916), probing depth (P=.832), probing attachment level (P=.096), implant stability (P=.338), bone level (P=.063), or bone density (P=.390) between the fully guided protocol and partially guided protocol.

CONCLUSIONS

The soft and hard tissues surrounding the implants placed by using fully guided surgical guides were clinically comparable with those placed by using partially guided surgical guides whether the guiding holes were cylindrical or C-shaped.

A correlation between bone (B), insertion torque (IT), and implant stability (S): BITS score

STATEMENT OF PROBLEM

Although criteria for assessing bone quality have been reported, an overall score that correlates bone quality with the primary stability and secondary stability of implants is not yet available.

PURPOSE

The purpose of this article was to propose a scoring index that will establish a correlation among the bone density values from computed tomography, maximum insertion torque values, and resonance frequency analysis in different phases of implant treatment.

MATERIAL AND METHODS

In this study, 60 implant sites were evaluated to assess bone density (Hounsfield units), insertion torque values (Ncm), and primary stability and secondary stability (implant stability quotient values obtained by using resonance frequency analysis). On the basis of computed tomography data, the bone was classified as D1 to D4. The insertion torque was noted and classified into 2 groups, A and B. The implant stability quotient values obtained from resonance frequency analysis depicting primary stability and secondary stability were classified into 5 groups. The primary score noted was a result of the values obtained for the 3 parameters at the time of implant placement. The secondary score was obtained by considering the values of the bone density and resonance frequency analysis recorded at different time intervals.

RESULTS

Bone densities of D2, D3, and D4 were noted, dividing the bone type into 3 groups. The maximum torque noted in the study was 40 Ncm. The difference between various insertion torque values and bone types was found to be statistically nonsignificant. Higher mean implant stability quotient values were obtained for primary and secondary stability for the D2 bone than for D3 and D4 bone. When analyzed according to the time of insertion, the mean values increased at second stage surgery in all bone types. The difference in mean values among all bone types was found to be statistically significant (P<.001). A comparison of primary and secondary implant stability quotient values in all bone types did not find any statistical significance (P=.780). A score was recorded at the time of implant placement and at the time of second stage surgery, and the prosthetic treatment was planned accordingly.

CONCLUSIONS

The score highlights the importance of considering the association of bone quality, insertion torque values, and stability as denoted by implant stability quotient throughout treatment. Based on the variation in the score noted at recall visits, alterations in the treatment plan can be made with respect to the healing period and prosthetic design.

Assessing bone's adaptive capacity around dental implants: a literature review

BACKGROUND

Increased stress (force) on prostheses induces strain (deformation) in the peri-implant bone. Elevated stress and strain could result in the failure of implants that support prostheses. However, the survival rate of implants supporting prostheses under increased stress is high. Either the bone is stronger than expected or it adapts to increased stress. Concepts regarding bone's adaptive capacity continue to evolve and are the focus of this literature review.

TYPES OF STUDIES REVIEWED

The authors searched the literature to find studies that addressed the bone's capacity to adjust to increased stress and strain. They assessed experimental and clinical trials in which investigators monitored healing after placement of dental implants.

RESULTS

The data indicate that forces greater than the bone's adaptive ability can induce loss of osseointegration, as well as osseous resorption. In contrast, it is possible that increased stress on prostheses initiates a reparative process, thereby facilitating retention of implants experiencing increased stress. Numerous lines of evidence support the concept that bone can modify itself to withstand increased mechanical forces.

PRACTICAL IMPLICATIONS

The authors provide an explanation for the high success rate of prostheses and implants in bone that are exposed to increased stress and strain.