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Wulbrand C, Müller F, Füchtmeier B, Hanke A. Therapy aspects of peri-implant femoral fractures-a retrospective analysis of 64 patients. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02508-9. [PMID: 38530409 DOI: 10.1007/s00068-024-02508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE The incidence of peri-implant femoral fractures (PIFF) is increasing. Information regarding outcomes, timing of surgery, risk factors, and a clinically applicable treatment algorithm are lacking. The aim of this study was to identify outcome-related risk factors and to derive a treatment algorithm. METHODS Sixty-four PIFFs treated between 01.01.2006 and 31.12.2020 in a level I trauma centre were evaluated retrospectively for fracture pattern, surgical technique, risk factors, complications, and 1-year mortality. The study was approved by the ethics committee (No. 21-2714-104). RESULTS One-year mortality was 24.1%. Surgical complications occurred in 4.7%, and general complications in 15.6% of the patients. General complications, low haemoglobin level at admission, elevated CHA2DS2-VASc, and Charlson score resulted in increased 1-year mortality. Time to surgery > 24 h did not increase complication or mortality rates. The three predominant fracture patterns were fractures close or distal to cephalomedullary nails, close or proximal to distal lateral plates, and close or distal to sliding hip screws. Recommendations for surgical treatment were derived: Osteosynthesis should enable as much weight-bearing as possible; the initial implant should only be removed, if this is essential for the new osteosynthesis; lateral locking plates should span the whole femur; antegrade nails should have a cephalomedullary component to avoid consecutive femoral neck fractures; implants should overlap to reduce the risk of consecutive inter-implant fractures. CONCLUSION Risk factors for 1-year mortality in patients with PIFFs were identified. A treatment algorithm and general principles for surgery of PIFFs were developed.
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Affiliation(s)
- Christian Wulbrand
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany.
| | - Franz Müller
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
| | - Bernd Füchtmeier
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
| | - Alexander Hanke
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
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Chen D, Li Z, Li Z, Sun Y, Liu Q, Yang J, Song J, Cai H, Feng Z, Chen Z, Huang B. Transcriptome analysis of human peri-implant soft tissue and periodontal gingiva: a paired design study. Clin Oral Investig 2023:10.1007/s00784-023-05017-y. [PMID: 37060358 DOI: 10.1007/s00784-023-05017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/02/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES Limited information is available about the biological characterization of peri-implant soft tissue at the transcriptional level. The aim of this study was to investigate the effect of dental implant on the soft tissue in vivo by using paired samples and compare the differences between peri-implant soft tissue and periodontal gingiva at the transcriptional level. METHODS Paired peri-implant soft tissue and periodontal gingiva tissue from 6 patients were obtained, and the pooled RNAs were analyzed by deep sequencing. Venn diagram was used to further screen out differentially expressed genes in every pair of samples. Annotation and enrichment analysis was performed. Further verification was done by quantitative real-time PCR. RESULTS Totally 3549 differentially expressed genes (DEGs) were found between peri-implant and periodontal groups. The Venn diagram further identified 185 DEGs in every pair of samples, of which the enrichment analysis identified significant enrichment for cellular component was associated with external side of plasma membrane, for molecular function was protein binding, for biological process was immune system process, and for KEGG pathway was cytokine-cytokine receptor interaction. Among the DEGs, CST1, SPP1, AQP9, and SFRP2 were verified to be upregulated in peri-implant soft tissue. CONCLUSIONS Peri-implant soft tissue showed altered expressions of several genes related to the cell-ECM interaction compared to periodontal gingiva. CLINICAL RELEVANCE Compared to periodontal gingiva, altered cell-ECM interactions in peri-implant may contribute to the susceptibility of peri-implant diseases. At the transcriptional level, periodontal gingiva is generally considered the appropriate control for peri-implantitis, except regarding the cell-ECM interactions.
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Affiliation(s)
- Danying Chen
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Zhixin Li
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Zhipeng Li
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Yue Sun
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Qifan Liu
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Jieting Yang
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Jiaying Song
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Huaxiong Cai
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Zhicai Feng
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Zhuofan Chen
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.
| | - Baoxin Huang
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.
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Costa JA, Mendes JM, Salazar F, Pacheco JJ, Rompante P, Câmara MI. Analysis of peri-implant bone defects by using cone beam computed tomography (CBCT): an integrative review. Oral Radiol 2023:10.1007/s11282-023-00683-w. [PMID: 37058184 DOI: 10.1007/s11282-023-00683-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/30/2023] [Indexed: 04/15/2023]
Abstract
The objective of this work was to perform an integrative review of the inspection of peri-implant bone defects using cone beam computed tomography (CBCT). An electronic search was performed in the PubMed database using the following scientific terms: CBCT or Cone Beam computed tomography; dental implant; peri-implant; bone loss; defects. The survey identified 267 studies, of which 18 were considered relevant to this study. These studies provided important data taking into account the accuracy of cone beam computed tomography in the detection and measurement of peri-implant bone defects such as fenestrations, dehiscence and intraosseous circumferential defects. The effectiveness of CBCT in aiding in geometric bone calculations and in the diagnosis of peri-implant defects was influenced by factors such as artefacts, defect size, bone wall thickness, implant material, adjustment of acquisition parameters and observer experience. A not insignificant number of studies compared intraoral radiography to CBCT in the detection of peri-implant bone loss. CBCT was clearly superior to intraoral radiography in the detection of all peri-implant bone defects, except for defects located in the interproximal zone. In general, studies have shown that peri-implant bone measurements adjacent to the implant surface can be correctly determined, as well as the diagnosis of peri-implant bone defects with an average discrepancy of less than 1 mm from the actual measurement of the defect.
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Affiliation(s)
- J A Costa
- Medicine and Oral Surgery Department, University Institute of Health Sciences (IUCS), CESPU, 4585-116, Gandra, Portugal.
| | - J M Mendes
- UNIPRO-Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), CESPU, 4585-116, Gandra, Portugal
| | - F Salazar
- UNIPRO-Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), CESPU, 4585-116, Gandra, Portugal
| | - J J Pacheco
- UNIPRO-Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), CESPU, 4585-116, Gandra, Portugal
| | - P Rompante
- UNIPRO-Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), CESPU, 4585-116, Gandra, Portugal
| | - M I Câmara
- Medicine and Oral Surgery Department, University Institute of Health Sciences (IUCS), CESPU, 4585-116, Gandra, Portugal
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Banu Raza F, Vijayaragavalu S, Kandasamy R, Krishnaswami V, Kumar V A. Microbiome and the inflammatory pathway in peri-implant health and disease with an updated review on treatment strategies. J Oral Biol Craniofac Res 2023; 13:84-91. [PMID: 36504486 PMCID: PMC9730223 DOI: 10.1016/j.jobcr.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/30/2022] [Accepted: 11/25/2022] [Indexed: 12/04/2022] Open
Abstract
Crestal bone preservation around the dental implant for aesthetic and functional success is widely researched and documented over a decade. Several etiological factors were put forth for crestal bone loss; of which biofilm plays a major role. Biofilm is formed by the colonization of wide spectra of bacteria inhabited around dental implants. Bacterial adherence affects the regulators of bone growth and an early intervention preserves the peri-implant bone. Primary modes of therapy stated in early literature were either prevention or treatment of infection caused by biofilm. This narrative review overviews the microbiome during different stages of peri-implant health, the mechanism of bone destruction, and the expression of the biomarkers at each stage. Microbial contamination and the associated biomarkers varied depending on the stage of peri-implant infection. The comprehensive review helps in formulating a research plan, both in diagnostics and treatment aspects in improving peri-implant health.
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Key Words
- Antibiotics
- Biomarkers
- CD14, Cluster of Differentiation 14
- CSF, Colony-Stimulating Factor
- Gene expression
- IL, Interleukins
- MMP 8, Matrix MetalloProteinase 8
- Microbiota
- OPG, Osteoprotegerin
- PSMB 2, Proteasome subunit beta type-2
- Peri-implant
- RANK, Receptor Activator of Nuclear factor Kappa-Β
- RANKL, Receptor Activator of Nuclear factor Kappa-ΒLigand
- TIMP, Tissue inhibitor of Metalloproteinase
- TNF, Tumor Necrosis Factor
- TWEAK, TNF-related weak inducer of apoptosis
- VEGF, Vascular Endothelial Growth Factor
- sRANKL, soluble Receptor Activator of Nuclear Factor-κB Ligand
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Affiliation(s)
- Fathima Banu Raza
- Department of Prosthodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | | | - Ruckmani Kandasamy
- Centre for Excellence in Nanobio Translational REsearch (CENTRE), Department of Pharmaceutical Technology, University College of Engineering, Anna University, BIT Campus, Tiruchirappalli, Tamil Nadu, India
| | - Venkateshwaran Krishnaswami
- Centre for Excellence in Nanobio Translational REsearch (CENTRE), Department of Pharmaceutical Technology, University College of Engineering, Anna University, BIT Campus, Tiruchirappalli, Tamil Nadu, India
| | - Anand Kumar V
- Department of Prosthodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
- Corresponding author. Department of Prosthodontics, Faculty of Dental Sciences, SRIHER (DU), Porur, Chennai, Tamil Nadu, India.
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Tokgöz SE, Bilhan H. The influence of the implant-abutment complex on marginal bone and peri-implant conditions: A retrospective study. J Adv Prosthodont 2021; 13:46-54. [PMID: 33747394 PMCID: PMC7943754 DOI: 10.4047/jap.2021.13.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The design of the implant-abutment complex is thought to be responsible for marginal bone loss (MBL) and might affect the condition of the peri-implant tissues. This the present study aimed to evaluate the influence of the implant-abutment complex on MBL and the peri-implant tissues in partially edentulous patients treated with dental implants and determine the most advantageous design. MATERIALS AND METHODS A total of ninety-one endosseous implants with different designs of implant-abutment complex [tissue level-TL (n = 30), platform switch-PS (n = 18), and platform match-PM (n = 43)] were reviewed for MBL, Probing Pocket Depth (PPD) and Bleeding on Probing (BoP). MBL was calculated for first year of the insertion and the following years. RESULTS The median MBL for the PM implants (2.66 ± 1.67 mm; n = 43) in the first year was significantly higher than those for the other types (P =.033). The lowest rate of MBL (0.61 ± 0.44 mm; n = 18) was observed with PS implants (P =.000). The position of the crown-abutment border showed a statisticallysignificant influence (P =.019) and a negative correlation (r=−0.395) on MBL. BoP was found significantly higher in PM implants (P =.006). The lowest BoP scores were detected in PS implants, but the difference was not significant (P =.523). The relation between PPD and connection type revealed no statistically significant influence (P >.05). CONCLUSION Within the limitations of the present study, it may be concluded that PS implants seem to show better peri-implant soft tissue conditions and cause less MBL.
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Affiliation(s)
- Selen Ergin Tokgöz
- Private Dental Practice, Prosthodontist, Dentaglobal Oral Health Centre, Bayraklı/İzmir, Turkey
| | - Hakan Bilhan
- Department of Periodontology, School of Dentistry, Faculty of Health Witten/Herdecke University, Alfred-Herrhausen Str. 45, Witten, Germany
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Breceda A, Sands A, Zderic I, Schopper C, Schader J, Gehweiler D, Mischler D, Richards G, Gueorguiev B. Biomechanical analysis of peri‑implant fractures in short versus long cephalomedullary implants following pertrochanteric fracture consolidation. Injury 2021; 52:60-65. [PMID: 32972726 DOI: 10.1016/j.injury.2020.09.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/13/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pertrochanteric femur fracture fixation with use of cephalomedullary nails (CMN) has become increasingly popular in recent past. Known complications after fracture consolidation include peri‑implant fractures following the use of both short and long nails, with fracture lines around the tip of the nail or through the interlocking screw holes, resulting in secondary midshaft or supracondylar femur fractures, respectively. Limited research exists to help the surgeon decide on the use of short versus long nails, while both have their benefits. The aim of this biomechanical study is to investigate in direct comparison one of the newest generations short and long CMNs in a human anatomical model, in terms of construct stability and generation of secondary fracture pattern following pertrochanteric fracture consolidation. METHODS Eight intact human anatomical femur pairs were assigned to two groups of eight specimens each for nailing using short or long CMNs. Each specimen was first biomechanically preloaded at 1 Hz over 2000 cycles in superimposed synchronous axial compression to 1800 N and internal rotation to 11.5 Nm. Following, internal rotation to failure was applied over an arc of 90° within one second under 700 N axial load. Torsional stiffness as well as torque at failure, angle at failure, and energy to failure were evaluated. Fracture patterns were analyzed. RESULTS Outcomes in the study groups with short and long nails were 9.7 ± 2.4 Nm/° and 10.2 ± 2.9 Nm/° for torsional stiffness, 119.8 ± 37.2 Nm and 128±46.7 Nm for torque at failure, 13.5 ± 3.5° and 13.4 ± 2.6° for angle at failure, and 887.5 ± 416.9 Nm° and 928.3 ± 461.0 Nm° for energy to failure, respectively, with no significant differences between them, p ≥ 0.17. Fractures through the distal locking screw holes occurred in 5 and 6 femora instrumented with short and long nails, respectively. Fractures through the lateral entry site of the head element were detected in 3 specimens within each group. For short nails, fractures through the distal shaft region, not interfacing with the implant, were detected in 3 specimens. CONCLUSION From a biomechanical perspective, the risk of secondary peri‑implant fracture after intramedullary fixation of pertrochanteric fractures is similar when using short or long CMN. Moreover, for both nail versions the fracture pattern does not unexceptionally involve the distal locking screw hole.
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Affiliation(s)
- Adam Breceda
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, Switzerland; Texas Bone & Joint, Denton, TX, United States.
| | - Andrew Sands
- New York Presbyterian - Lower Manhattan Hospital New York, NY, United States.
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, Switzerland.
| | - Clemens Schopper
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, Switzerland; Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University, Linz, Austria.
| | - Jana Schader
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, Switzerland.
| | - Dominic Gehweiler
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, Switzerland.
| | - Dominic Mischler
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, Switzerland.
| | - Geoff Richards
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, Switzerland.
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, Switzerland.
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Cantó-Navés O, Marimon X, Ferrer M, Cabratosa-Termes J. Comparison between experimental digital image processing and numerical methods for stress analysis in dental implants with different restorative materials. J Mech Behav Biomed Mater 2020; 113:104092. [PMID: 33010696 DOI: 10.1016/j.jmbbm.2020.104092] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/08/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022]
Abstract
The aim of this study is to evaluate the stresses transferred to peri-implant areas from single implants restored with different restorative materials and subjected to a static vertical load with low eccentricity. A total of 12 crowns were made with four types of materials: carbon fiber-composite, metal-ceramic, metal-composite, and full-metal, all of them cemented over a titanium abutment. Three different ways of approaching the problem have been used independently to verify the robustness of the conclusions. The experimental results of stress distribution around the implant were obtained by two image processing techniques: Digital Photoelasticity and Digital Image Correlation (DIC). The tests have been modelled by 3D Finite Element Method (FEM). The FEM models have also been used to study the sensitivity of the results to slight changes in geometry or loads, so that the robustness of the experimental techniques can be analyzed. In addition, the realistic bone morphology of the mandible has also been modelled by FEM, including the cortical and trabecular bone property distinctions.
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Affiliation(s)
- Oriol Cantó-Navés
- Faculty of Dentistry, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Xavier Marimon
- Automatic Control Department, Universitat Politècnica de Catalunya (UPC-BarcelonaTECH), Barcelona, Spain.
| | - Miquel Ferrer
- Department of Strength of Materials and Structural Engineering, Universitat Politècnica de Catalunya (UPC-BarcelonaTECH), Barcelona, Spain
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Tenore G, Montori A, Mohsen A, Mattarelli G, Palaia G, Romeo U. Evaluation of adjunctive efficacy of diode laser in the treatment of peri-implant mucositis: a randomized clinical trial. Lasers Med Sci 2020; 35:1411-1417. [PMID: 32304001 DOI: 10.1007/s10103-020-03009-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 03/25/2020] [Indexed: 12/16/2022]
Abstract
Peri-implant disease may affect survival of dental implants. The aim of the study is to analyze the effectiveness of diode laser as a supportive modality to the non-surgical conventional treatment of peri-implant mucositis (PiM) and initial peri-implantitis (PI). Twenty-three patients with single implants suffering from PiM or initial PI were selected and randomly divided into two groups; control group (CG) received non-surgical conventional treatment, and test group (TG) received non-surgical conventional treatment and diode laser application with wavelength of 980 nm. Probing pocket depth (PPD) and bleeding on probing (BOP) were recorded at baseline (T0) and at 3 months follow-up (T1). The average of PPD value for TG was 4.04 ± 0.54 mm at T0 and it was 2.98 ± 0.70 mm at T1. In the CG, PPD average was 3.8 ± 1.24 mm at T0 and was 3.54 ± 0.35 mm at T1. In TG, the BOP was positive in 44 sites at T0 and in 6 sites at T1. In CG, the BOP was positively observed in 52 sites at T0 and in 28 sites at T1. The 980-nm diode laser may be considered an adjunct to the conventional non-surgical treatments of PiM and initial PI.
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Affiliation(s)
- Gianluca Tenore
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Via Caserta 6, 00161, Rome, Italy
| | - Alessandra Montori
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Via Caserta 6, 00161, Rome, Italy
| | - Ahmed Mohsen
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Via Caserta 6, 00161, Rome, Italy.
| | - Giovanni Mattarelli
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Via Caserta 6, 00161, Rome, Italy
| | - Gaspare Palaia
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Via Caserta 6, 00161, Rome, Italy
| | - Umberto Romeo
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Via Caserta 6, 00161, Rome, Italy
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Tekin MB, Toker H. The effect of hyperlipidemia on bone graft regeneration of peri-implantal created defects in rabbits. Int J Implant Dent 2019; 5:18. [PMID: 31089911 DOI: 10.1186/s40729-019-0170-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/15/2019] [Indexed: 12/05/2022] Open
Abstract
Aim It is reported that hyperlipidemia affects quality and density of bone and adversely affects wound healing. The effect of hyperlipidemia on implant osseointegration and peri-implant defect regeneration has not been fully explained. The purpose of this study was to examine the effects of hyperlipidemia on the healing potential of the materials used for peri-implant bone regeneration and implant stability. Materials and methods Twelve male, New Zealand rabbits were used in this study. Half of the rabbits were fed a 2% cholesterol diet for 8 weeks to induce hypercholesterolemia. Peri-implant defects (7 mm diameter) were created in the tibias of rabbits and placed implants (3.3 mm in diameter). This study was conducted as a split-mouth design. Animals were randomly divided into two groups: (1) hypercholesterol+autogenous graft group and hypercholesterol+xenograft group (n = 6), and (2) autogenous graft and xenograft groups as controls (n = 6). At 8 weeks after surgery, the rabbits were euthanized. During implant surgery and at 8 weeks, implant stability was measured with resonance frequency analysis (RFA values). Bone-to-implant contact (BIC) was analyzed via histomorphometric analysis. Results Hyperlipidemic groups showed significantly lower BIC values than those of the control groups at 8 weeks (p < 0.05). According to baseline RFA readings, there was no significant difference between control and hyperlipidemic groups (p ˃ 0.05). The hypercholesterol+autogenous graft group had significantly lower RFA readings and BIC values than the hypercholesterol+xenograft group at 8 weeks (p < 0.05). Conclusion Within the limitations of this study, it was found that hyperlipidemia may negatively affect the implant stability especially in the autogenous group and also, may decrease peri-implant bone regeneration. However, further studies are necessary to confirm these results more.
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Abstract
INTRODUCTION Extraction of broken femoral nails in peri-implant fractures is becoming an increasingly common problem faced by orthopaedic surgeons. Different closed and open techniques for removal of broken nails have been previously described but due to variations in equipment and fracture configurations these methods are not always easily reproducible. We describe an open surgical technique using simple equipment that can be utilised when other methods of extraction have failed. CASE PRESENTATION AND SURGICAL TECHNIQUE We present a case of a peri-implant fracture secondary to non-union involving a short cephalomedullary nail where the broken distal segment of nail was significantly more distal to the femoral fracture site. After multiple failed attempts at extraction with previously described closed techniques a rectangular cortical window was created 2cm distal to the tip of the broken nail using a saw. An antegrade guide wire was passed through the nail and pulled out of the bony window. A flexible intramedullary reamer was subsequently passed in retrograde fashion over the guide wire and a simple pushout technique was used to push both segments of the broken nail through the original insertion site. An exchange nailing was performed and the cortical window was reattached using a cable. DISCUSSION This is a simple technique that does not require any specialist equipment and does not require the fracture site to be disturbed. The use of a flexible reamer as a pushout device is ideal as there are multiple size options allowing the surgeon to match the size of the medullary canal with the reamer. Furthermore, the flexibility of the reamer allows easy access through a lateral bone window. CONCLUSION Broken femoral nail extraction can be technically challenging and when other closed methods have failed we believe our technique offers a simple alternative that can be added to the armamentarium of solutions.
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Affiliation(s)
- C Zhao
- Maidstone and Tunbridge Wells Hospitals Trust, Tunbridge Wells, United Kingdom.
| | - G J R Slater
- Maidstone and Tunbridge Wells Hospitals Trust, Tunbridge Wells, United Kingdom.
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Graves CV, Harrel SK, Rossmann JA, Kerns D, Gonzalez JA, Kontogiorgos ED, Al-Hashimi I, Abraham C. The Role of Occlusion in the Dental Implant and Peri-implant Condition: A Review. Open Dent J 2016; 10:594-601. [PMID: 27990184 PMCID: PMC5123128 DOI: 10.2174/1874210601610010594] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/28/2016] [Accepted: 10/15/2016] [Indexed: 11/22/2022] Open
Abstract
Dental implants have become a widely used dental treatment approach. It is important to identify factors that can be detrimental to dental implants and the peri-implant complex. There is controversy regarding whether occlusion plays a role in the implant and peri-implant condition. The present study aims to review the scientific literature regarding this topic. Animal and human studies, and previous reviews on the topic are included and presented. There is a wide heterogeneity among study designs. Several articles demonstrated that occlusion and occlusion overload could detrimentally affect the peri-implant condition, while other articles did not support these results. More studies are needed to help understand the mechanisms by which occlusion might play a role in the peri-implant condition.
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Affiliation(s)
- Carmen V Graves
- Periodontics Department, Texas A&M Baylor College of Dentistry, Dallas, Texas, USA
| | - Steve K Harrel
- Periodontics Department, Texas A&M Baylor College of Dentistry, Dallas, Texas, USA
| | - Jeffrey A Rossmann
- Periodontics Department, Texas A&M Baylor College of Dentistry, Dallas, Texas, USA
| | - David Kerns
- Periodontics Department, Texas A&M Baylor College of Dentistry, Dallas, Texas, USA
| | - Jorge A Gonzalez
- Center of Maxillofacial Prosthesis, Texas A&M Baylor College of Dentistry, Dallas, Texas, USA
| | - Elias D Kontogiorgos
- Restorative Science and Implant Dentistry, Texas A&M Baylor College of Dentistry, Dallas, Texas, USA
| | - Ibtisam Al-Hashimi
- Periodontics Department, Texas A&M Baylor College of Dentistry, Dallas, Texas, USA
| | - Celeste Abraham
- Periodontics Department, Texas A&M Baylor College of Dentistry, Dallas, Texas, USA
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Sala L, Bascones-Martínez A, Carrillo-de-Albornoz A. Impact of abutment material on peri-implant soft tissue color. An in vitro study. Clin Oral Investig 2016; 21:2221-2233. [PMID: 27878464 DOI: 10.1007/s00784-016-2015-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The objectives of the present study is to determine the differences in peri-implant soft tissue color with the utilization of titanium, titanium gold-plated, white zirconia, Vita Classical (VC) A4-shaded zirconia, and fluorescent white zirconia abutments and to establish the influence of gingival thickness on the resulting color. METHODS Four implants were contralaterally inserted in 19 fresh pig mandibles, and the color of the peri-implant mucosa with the different abutments was spectrophotometrically measured at 1-, 2-, and 3-mm height from the margin. RESULTS At 1-mm height, titanium significantly differed from all zirconia abutments in lightness (L*), chroma along red axis (a*), and chroma along yellow-blue axis (b*) parameters. At 2 mm, all zirconia abutments differed from titanium in b* but only fluorescent zirconia in a*. At 3 mm, titanium differed from VC A4-shaded and fluorescent zirconia abutments in b*. At soft tissue thicknesses <1 and 1-2 mm, titanium differed from fluorescent zirconia in a* and b* and from VC A4-shaded zirconia in b*; at thickness >2 mm, no differences were found among abutments. All abutments differed from natural teeth in a* and b* at all heights and thicknesses except for fluorescent zirconia at thickness >2 mm. The Euclidean distance (ΔΕ) differed between titanium abutments and gold, VC A4, and fluorescent zirconia at <1- and 1-2-mm thicknesses. CONCLUSION The natural gingival color was not reproduced with any abutment at gingival thicknesses <2 mm. The worst color match was with titanium abutments and the best with fluorescent zirconia, followed by VC A4-shaded zirconia. At gingival thicknesses >2 mm, no differences were detected among abutments. CLINICAL RELEVANCE This study demonstrates that the type of abutment and the gingival thickness affect the resulting peri-implant gingival color.
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Affiliation(s)
- Leticia Sala
- Department of Periodontology, School of Dentistry, Complutense University of Madrid, Madrid, Spain.
- Departmento de Estomatología III, Facultad de Odontología, Universidad Complutense de Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain.
| | - Antonio Bascones-Martínez
- Department of Periodontology, School of Dentistry, Complutense University of Madrid, Madrid, Spain
- Departmento de Estomatología III, Facultad de Odontología, Universidad Complutense de Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain
| | - Ana Carrillo-de-Albornoz
- Department of Periodontology, School of Dentistry, Complutense University of Madrid, Madrid, Spain
- Departmento de Estomatología III, Facultad de Odontología, Universidad Complutense de Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain
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Müller F, Galler M, Zellner M, Bäuml C, Marzouk A, Füchtmeier B. Peri-implant femoral fractures: The risk is more than three times higher within PFN compared with DHS. Injury 2016; 47:2189-2194. [PMID: 27370170 DOI: 10.1016/j.injury.2016.04.042] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/27/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Information is lacking regarding incidence rates, treatment regimens, and outcomes concerning peri-implant femoral fractures (PIF). Therefore, we performed a retrospective study to provide scientific data concerning incidence and outcome of PIF following osteosynthesis of proximal femoral fractures (PFF). MATERIAL AND METHODS We retrospectively included all patients who received osteosynthesis for PFF between 2006 and 2015 and in whom PIF was confirmed postoperatively. All available patients with PIF were contacted minimum one year post-surgery. RESULTS A total of 1314 osteosynthesis procedures were performed, of which 705 were proximal femoral nails (PFNs), 597 were dynamic hip screws (DHSs), and 12 were screws appliances only. During the same period, 18 PIFs (1.4%) were reported. However, PIF was 3.7 times higher within PFN when compared to DHS (15/705:2.1% versus 3/597:0.5%; odds ratio: 3.7). The following analysis also included 8 patients with PIF who were referred from other hospitals, resulting in a total of 26 patients. Mean patient age was 84.8 years (range, 57-95), with a predominance in female (23×) and in the left femur (19×). PIF occurred after an average of 23.6 months (range, 1-81) post-surgery. The fractures, most of which were spiral-shaped, were most commonly treated with locking plate osteosynthesis. The surgical revision rate was 7.7%, and the one-year mortality was 23.1%. At an average of 43.0 months (range, 12-100) post-surgery, it was possible to contact 18/26 patients (69.2%), and their mean Parker Mobility Score was 5.2 points (range 2-9). CONCLUSIONS Peri-implant femoral fracture is a rare incident within the old age traumatology of PFF. However, based on our small number of cases, it occurred within PFN much more frequently compared with DHS. Locking plate osteosynthesis has been shown to be effective and reliable. Surgical revision and mortality rates do not appear to be increased when compared to those with the initial treatment of proximal femoral fractures.
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Affiliation(s)
- F Müller
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany.
| | - M Galler
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany
| | - M Zellner
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany
| | - C Bäuml
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany
| | - A Marzouk
- Fellowship AO Foundation, Sohag University, 82524 Egypt
| | - B Füchtmeier
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany
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Kumar VV, Jacob PC, Kuriakose MA. Sub-Periosteal Dissection with Denture-Guided Epithelial Regeneration: A Novel Method for Peri-Implant Soft Tissue Management in Reconstructed Mandibles. J Maxillofac Oral Surg 2015; 15:449-455. [PMID: 27833336 DOI: 10.1007/s12663-015-0854-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/21/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND In patients with reconstructed mandibles using free fibula flaps, management of soft tissues around implants supporting dental rehabilitation, is often a clinical problem. AIM The aim of this paper is to describe a new technique, namely "Sub-periosteal dissection and denture-guided epithelial regeneration (SD-DGER)", as a method of peri-implant soft tissue management in these patients. MATERIALS AND METHODS The technique consists of performing a subperiosteal dissection with creation of buccal and lingual flaps. These flaps form the buccal and lingual vestibule. Implants are placed and an interim denture is immediately loaded onto the implants to guide the regenerated epithelium. A keratinized mucosal layer is formed on the bare fibula bone in six months time. RESULTS This technique was successful in producing fixed keratinized epithelial tissue around implants in patients with mandibles reconstructed using the free fibula flap in patients who did not undergo radiotherapy. CONCLUSION The sub-periosteal dissection with denture guided epithelial regeneration is a predictable form of peri-implant soft tissue management in selected patients with reconstructed jaws.
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Affiliation(s)
- Vinay V Kumar
- Department of Surgical Oncology- Head and Neck Surgery, Majumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bengaluru, India ; Department of Oral and Maxillofacial Surgery, M.R. Ambedkar Dental College & Hospital, 37, Lazar Layout, Frazer Town, Bengaluru, 560005 India ; Department of Oral Maxillofacial and Plastic Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - P C Jacob
- Department of Prosthodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, India ; Ora-Care Dental Clinic, 81-Coles Road, Frazer Town, Bengaluru, India
| | - Moni A Kuriakose
- Department of Surgical Oncology- Head and Neck Surgery, Majumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bengaluru, India
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Ragamouni S, Kumar JM, Mushahary D, Nemani H, Pande G. Histological analysis of cells and matrix mineralization of new bone tissue induced in rabbit femur bones by Mg-Zr based biodegradable implants. Acta Histochem 2013; 115:748-56. [PMID: 23628266 DOI: 10.1016/j.acthis.2013.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 02/22/2013] [Accepted: 02/27/2013] [Indexed: 10/26/2022]
Abstract
The biological efficacy of bone inducing implant materials in situ can be assessed effectively by performing histological analysis. We studied the peri-implant bone regeneration around two types of biodegradable magnesium-zirconium alloys, Mg-5Zr and Mg-Zr-2Sr, using histological, histochemical and immunohistochemical methods in the femur of New Zealand White strain rabbits. Our study includes three animal groups: (a) Mg-5Zr, (b) Mg-Zr-2Sr and (c) control. In each group three animals were used and in groups 'a' and 'b' the respective alloys were implanted in cavities made at the distal ends of the femur; control animals were left without implants to observe natural bone healing. Qualitative assessment of the cellularity and matrix mineralization events of the newly formed bone tissue was done at three months after implantation by histological methods in methyl methacrylate embedded tissue without decalcifying the bone. Quantitative mineral content and density of the new bone (NB) were evaluated by the statistical analysis of dual energy X-ray absorptiometry (DXA) data obtained from three animals in each experimental group. Based on our analysis we conclude that Mg-Zr-2Sr alloy showed better osseointegration of the newly formed bone with the implant surface. Our methodology of studying peri-implant osteoinduction of degradable implants using low temperature methyl methacrylate embedding resin can be useful as a general method for determining the bio-efficacy of implant materials.
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