 and patient-related variables were analyzed by generalized estimating equations (GEEs) of multilevel logistic regression models.
Results: Based on an a priori power calculation, 332 implants were screened in 47 peri-implantitis patients. Of these, 158 peri-implantitis implants were eligible. The most prevalent defect morphology type was class Ib (55%) followed by class Ia (16.5%), and class IIIb (13.9%). On the contrary, the less frequent defect was class II (1.9%). The most frequent degree of severity was M (50.6%) with S (10.1%) being the least prevalent. Buccal bone loss was significantly greater compared to the other bony walls in class I and class III defects. Age was associated with the type of defect. Age and smoking habit were associated with the morphology of the defects, while smoking habit, type of prosthesis and distance to adjacent implant were associated with the severity of the defects (vertical bone loss).
Conclusion: Peri-implantitis defects frequently course with an infraosseous component and often with buccal bone loss. Certain patient-, implant-, and site-specific variables are related with defect morphology and severity. However, morphological patterns for peri-implantitis bone defects could not be proven (NCT NCT03777449).
Guided Bone Regeneration in Alveolar Bone Reconstruction.
Guided bone regeneration is an effective alternative for the reconstruction of atrophic ridges. Adequate flap management together with immobilization of the barrier membrane and graft are crucial to ensure successful regenerative radiographic and clinical outcomes. Moreover, tension-free flap closure should be accomplished to guarantee to maximize the effectiveness of guided bone regeneration.
The prevalence of implant biological complications has grown enormously over the last decade, in concordance with the impact of biofilm and its byproducts upon disease development. Deleterious habits and systemic conditions have been regarded as risk factors for peri-implantitis. However, little is known about the influence of local confounders upon the onset and progression of the disease. The present narrative review therefore describes the emerging local predisposing factors that place dental implants/patients at risk of developing peri-implantitis. A review is also made of the triggering factors capable of inducing peri-implantitis and of the accelerating factors capable of interfering with the progression of the disease.
Effectiveness of vertical ridge augmentation interventions: A systematic review and meta-analysis.
Aim: The primary aim of this systematic review was to evaluate the effect of various techniques used for vertical ridge augmentation on clinical vertical bone gain.
Material And Methods: A protocol was developed to answer the following focused question: "In patients with vertical alveolar ridge deficiencies, how effective are different augmentation procedures for clinical alveolar ridge gain?" Randomized and controlled clinical trials and prospective and retrospective case series were included, and meta-analyses were performed to evaluate vertical bone gain based on the type of procedure and to compare bone gains in controlled studies.
Results: Thirty-six publications were included. Results demonstrated a significant vertical bone gain for all treatment approaches (n = 33; weighted mean effect = 4.16 mm; 95% CI 3.72-4.61; p < 0.001). Clinical vertical bone gain and complications rate varied among the different procedures, with a weighted mean gain of 8.04 mm and complications rate of 47.3% for distraction osteogenesis, 4.18 mm and 12.1% for guided bone regeneration (GBR), and 3.46 mm and 23.9% for bone blocks. In comparative studies, GBR achieved a significant greater bone gain when compared to bone blocks (n = 3; weighted mean difference = 1.34 mm; 95% CI 0.76-1.91; p < 0.001).
Conclusions: Vertical ridge augmentation is a feasible and effective therapy for the reconstruction of deficient alveolar ridges, although complications are common.
J Periodontol 2019 05 7;90(5):445-453. Epub 2018 Dec 7.
Department of Periodontology, International University of Catalonia, Barcelona, Spain.
Background: Given the fact that most patients are not regular compliers in supportive peri-implant maintenance programs, it is of interest to examine the significance of the peri-implant soft tissue characteristics in relationship to the onset of peri-implant diseases.
Methods: Based on an a priori statistical power calculation, a cross-sectional study was conducted on erratic peri-implant maintenance compliers (<2 times/year) to examine the significance of keratinized mucosa (KM) and gingival tissue (KT) on peri-implant and adjacent periodontal conditions in implants restored ≥3 years. Seven clinical parameters were recorded around implants and the adjacent buccal sites. Radiographic assessment was performed using periapical X-rays. In addition, a visual analog scale (VAS) was used to evaluate the impact of KM upon brushing comfort. The case definition used for peri-implant diseases was in accordance with the 2017 World Workshop on the classification of periodontal and peri-implant diseases and conditions.
Results: Overall, 37 patients with 45 edentulous gaps restored with 66 implants and 90 adjacent teeth were analyzed. On comparing a KM band of <2 mm versus ≥2 mm, with the exception of suppuration (P = 0.6), all the clinical and radiographic parameters were significantly increased when the KM band was <2 mm (P < 0.001). A significant correlation was observed between KM and KT (r = 0.55), though a lack of KM did not condition a lack of KT. In the presence of peri-implantitis, only bleeding on probing at the adjacent dentate sites was identified to be increased.
Conclusions: The presence of <2 mm of KM around dental implants in erratic maintenance compliers seems to be associated with peri-implant diseases. The lack of KM constitutes a site-specific phenomenon independent of the keratinized tissue present in the adjacent dentition (NCT03501537).
Material And Methods: Electronic and manual literature searches were conducted. Implant failure (IF) was the primary outcome, while biological/mechanical and the causes/timing associated with IF were set as secondary outcomes. Meta-analyses for the binary outcome IF and odds ratio were performed to investigate the association with medications.
Results: A final selection of 17 articles was screened for qualitative assessment. As such, five studies focused on evaluating the association of implant failure and non-steroidal anti-inflammatory drugs (NSAIDs), two on selective serotonin reuptake inhibitors (SSRIs), two on proton pump inhibitors (PPIs), seven on bisphosphonates (BPs), and one on anti-hypertensives (AHTNs). For PPIs, the fixed effect model estimated a difference of IF rates of 4.3%, indicating significantly higher IF rates in the test compared to the control group (p < 0.5). Likewise, for SSRIs, the IF was shown to be significantly higher in the individuals taking SSRIs (p < 0.5) as estimated a difference of 7.5%. No subset meta-analysis could be conducted for AHTNs medications as only one study fulfilled the inclusion criteria, which revealed an increased survival rate of AHTN medication. None of the other medications yielded significance.
Conclusions: The present systematic review showed an association of PPIs and SSRIs with an increased implant failure rate. Hence, clinicians considering implant therapy should be aware of possible medication-related implant failures.
Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts.
Aim: To investigate and compare the prevalence of biological complications and failure of implants placed in pristine vs. augmented sites after a mean observation period of at least 10 years.
Materials And Methods: The focused question "In patients with osseointegrated dental implants, are there differences in biological complications and implant failure at implants placed in pristine vs. augmented sites?" was addressed using the Population, Exposure, Comparison and Outcome criteria. Electronic and manual searches supplemented by the screening of the grey literature were carried out. A case definition of peri-implant mucositis and peri-implantitis had to be specified. The binary random-effects method was chosen to conduct meta-analyses. Results are presented as Forest plots with weighted mean values and 95% confidence intervals (CI). The I statistic test was applied to quantify heterogeneity. The Newcastle-Ottawa Scale and the parameters provided in the Cochrane Center and CONSORT statement were used for quality assessment. The results are reported according to the PRISMA guidelines.
Results: No randomized clinical trial (RCT) comparing the outcomes of implants placed in pristine vs. augmented sites was identified. Five case-series studies, one case-control study, one cross-sectional study and one RCT were eligible for qualitative and quantitative analyses. No statistically significant differences (p >.05) were observed between implants placed in pristine vs. augmented sites for any outcome variables both at patient and at implant levels, respectively. High heterogeneity concerning patient sampling, case definitions of biological complications and eligibility criteria was observed.
Conclusion: The studies included in the present systematic review did not directly address the focused questions. Hence, the outcomes of the meta-analysis should be interpreted with caution due to high variability with respect to study design.
Diagnostic accuracy of the implant stability quotient in monitoring progressive peri-implant bone loss: An experimental study in dogs.
Clin Oral Implants Res 2018 Oct 28;29(10):1016-1024. Epub 2018 Sep 28.
Department of Oral Surgery and Stomatology, ZMK School of Dental Medicine, University of Bern, Bern, Switzerland.
Objectives: To investigate the impact of progressive bone loss in an experimental peri-implantitis model in the dog upon the implant stability quotient (ISQ) measured in the course of induced and spontaneous conditions of disease, and to evaluate