Evaluation of hard tissue replacement composite graft material as a ridge preservation/augmentation material in conjunction with immediate hydroxyapatite-coated dental implants

BACKGROUND: Immediate placement of dental implants (DI) in fresh extraction sockets is associated with remaining voids around the DI and often a partial dehiscence or thin facial alveolar plate. Bone replacement grafts are often used to correct these problems. This study evaluated the use of a layered composite of PMMA (poly-methyl-methacrylate), PHEMA (poly-hydroxyl-ethyl-methacrylate), and calcium hydroxide grafts (HTR) as a ridge preservation/ augmentation material used in conjunction with an immediate DI placement technique. METHODS: Twenty-three patients requiring 1 or 2 extractions that were treatment planned for immediate DI placement received 4.0 or 3.25 mm diameter hydroxyapatite-coated cylindrical implants in the extraction sockets. HTR was used to fill the remaining socket void and enhance the facial ridge width. A collagen hemostatic was placed to cover the DI sites, flaps released, and primary closure attempted with sutures. DI uncovering was performed at about 6 months. Measurements were taken to the nearest 0.5 mm of the internal socket width and total ridge width at DI placement and uncovering. RESULTS: Thirty DIs were placed in the 23 patients. Mean initial internal socket width was 6.9 mm. The total ridge width showed a mean change from 9.1 mm to 8.4 mm; 60% of the areas showed a net increase or no change, while 40% showed a decrease in overall ridge width. DI success rate was 97% out to 6 months of loading. CONCLUSION: The results of this study suggest that HTR is a useful adjunct in the placement of immediate DIs for filling of socket voids and preservation of ridge width.     

Use of HTR synthetic bone as an augmentation material in conjunction with immediate implant placement: a case report

Immediate placement of dental implants (DI) in fresh extraction sockets is associated with remaining voids around the DI and often a partial dehiscence or thin facial alveolar plate. Bioplant HTR synthetic bone (HTR) was used as a ridge preservation/augmentation material in conjunction with this method of DI placement. A 61-year-old white woman requiring extraction of tooth 12 opted for immediate DI placement. HTR was used to fill the remaining socket void and enhance the facial ridge width, and primary closure was attempted with sutures. DI uncovering was performed at about 6 months. Measurements were taken to the nearest 0.5 mm of the internal socket width and total site width at DI placement and uncovering. The internal socket width was essentially maintained (6.8 vs 6.6 mm), and the total ridge width showed a change from 8.7 to 9.1 mm. The results of this case suggest that HTR is a useful adjunct in the placement of immediate DIs for the preservation of ridge width.     

Neurosensory disturbances of the inferior alveolar nerve: a retrospective study of complaints in a 10-year period.

PURPOSE: The aim of this study was to evaluate the prevalence of neurosensory disturbances (NSDs) of the inferior alveolar nerve after dental procedures. MATERIALS AND METHODS: A retrospective study of patient complaints for transient and permanent NSDs was achieved by means of a 10-year follow-up of claims to a national practitioner insurance company. Claims for 3 different dental procedures were analyzed from 157,292 contracts of insurance recorded during this period. RESULTS: Three hundred eighty-two complaints of NSDs were recorded with 75 permanent injuries (19.6%). The incidence of endodontic treatment and surgical procedures in NSDs cases were 35.3% and 61.5%, respectively, and the prevalence of third molar removals in permanent loss of sensation was 46.6%. CONCLUSION: Impacted third molar removal appears to be the main etiology of permanent inferior alveolar nerve sensory deficiency, but endodontic treatments are often implicated and implant placement procedures can cause severe nerve injuries.     

One-year follow-up of first consecutive 100 zirconia dental implants in humans: a comparison of 2 different rough surfaces

PURPOSE: The aim of this study was to evaluate the success rate of 100 consecutive zirconia dental implants with 2 different rough surfaces after 1 year of follow-up. MATERIALS AND METHODS: One-piece zirconia dental implants (CeraRoot, Barcelona, Spain) with 1 of 2 different roughened surfaces were designed and manufactured for this study. Five different implant designs were manufactured. Standard or flapless surgical procedures were used for implant placement. Simultaneous bone augmentation or sinus elevation were performed in the cases where bone height or width was insufficient. Implants in the anterior region (canine to canine) were immediately restored with provisional prostheses. Implants placed using less than 35 N torque were splinted with composite resin using an etched and bonded approach to the neighboring teeth or implants to minimize implant mobility and failure. Definitive all-ceramic restorations were placed 4 months after implant placement (8 months for implants where bone augmentation or sinus elevation was performed). RESULTS: The study included 36 patients with a mean age of 50 years. The overall implant success rate after 1 year of follow-up was 98% in both the coated and noncoated groups. CONCLUSIONS: From the preliminary results of this investigation, it can be concluded that zirconia dental implants with roughened surfaces might be a viable alternative for tooth replacement. Further follow-up is needed to evaluate the long-term success rates of the implant surfaces studied.     

Selective serotonin reuptake inhibitors as a risk factor for dental implant failure: a retrospective clinical study

The trend in recent decades in Europe and the United States points to an exponential increase in the consumption of antidepressant drugs and, in particular, selective serotonin reuptake inhibitors (SSRIs). This retrospective study aimed to investigate whether there is an association between SSRI intake and dental implant (DI) failure or survival and, secondarily, to investigate the influence of other systemic and local factors. This retrospective cohort study was done in accordance with the the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for observational studies. A total of 170 patients received 573 DIs between 2014 and 2020.The reported DI failure rate was 6.11% (n = 35 DIs). Of these 18.31% failed in patients treated with SSRIs while 4.38% failed in patients who were not prescribed SSRIs (p < 0.001). Specifically, use of these drugs was associated with a hazard ratio rate of DI failure that was 4.53 times higher (95% CI: 1.93 to 10.61), and in the multivariate analysis, a 3.70 times higher adjusted risk was found. A lower DI survival rate at 90 months’ follow up was also observed in these patients compared with those not taking them (84.30% vs 96%, respectively; p = 0.00014). With the limitations of the present study it can be affirmed that there is a relation between the intake of SSRIs and DI failure, as well as a lower survival rate in these patients.     

Severely resorbed mandible: predictable reconstruction with soft tissue matrix expansion (tent pole) grafts.

PURPOSE: Attempts to reconstruct the severely resorbed mandible (or=3 years). CONCLUSIONS: The novel strategy of this surgery whereby bone grafts consolidate and maintain their volume by dental implants that creates a tenting effect offers predictable long-term reconstruction of the severely resorbed mandible without the complications observed with other approaches.     

Complications associated with inferior alveolar nerve repositioning for dental implant placement: a systematic review

Inferior alveolar nerve (IAN) repositioning has been used widely in recent years as an alternative approach for dental implant placement in the atrophic posterior mandible. The aim of this study was to answer the question: What are the complications associated with IAN repositioning? A systematic literature review performed in accordance with the PRISMA statement, using the PubMed (MEDLINE), Cochrane Library, and Scopus databases, identified a total of 116 articles related to this technique. Of those articles, 24 were included in the final review. Lateralization was the chosen technique in seven studies, transposition in 15 studies, and two studies reported both techniques. The longest follow-up period was 49.1 months and the shortest 6 months. Of the patients who underwent lateralization, 95.9% initially showed a neurosensory disturbance, and the condition remained at the end of the study for 3.4% of those patients. With regard to the patients who underwent transposition, neurosensory alterations were observed in 58.9% of patients initially, and the condition remained for 22.1% of those affected at the end of the study. Only one study found no neurosensory disturbance at any time. More data consolidation is necessary to determine scientifically if, which, and when the IAN repositioning technique can be recommended.     

Complications in alveolar distraction osteogenesis of the atrophic mandible

To improve the starting point for placement of dental implants, 45 patients suffering from atrophied edentulous mandibles, with a vertical height varying between 7.3 and 15.8mm, were treated by alveolar vertical distraction osteogenesis (VDO). The mean follow-up period was 3 years, ranging from 1 to 7 years. Associated complications, as occurred during instalment of the distractor device, VDO period and consolidation phase, and also after dental implant placement, were evaluated. Observed complications were: early fractures (2%), late fractures (17%), bleeding or haematoma (4%), infections (6%), skin perforation (2%), mucosal dehiscence (8%), sensory disturbances (28%), sagging chin (13%) and failure of dental implants (13%). In 10 patients 2 complications and in 1 patient 3 complications were monitored. All complications occurred in the first year. It is concluded that VDO to restore vertical bone height in patients with mandibular atrophy is a surgically delicate technique with a high risk of various complications. The likelihood of the most striking complication, namely fracture occurrence, increases with decreasing residual bone height.     

Iatrogenic trigeminal post-traumatic neuropathy: a retrospective two-year cohort study

With the growing demand for dental work, trigeminal nerve injuries are increasingly common. This retrospective cohort study examined 53 cases of iatrogenic trigeminal nerve injury seen at the Department of Oral and Maxillofacial Surgery, University Hospitals of Leuven between 2013 and 2014 (0.6% among 8845 new patient visits). Patient records were screened for post-traumatic trigeminal nerve neuropathy caused by nerve injury incurred during implant surgery, endodontic treatment, local anaesthesia, tooth extraction, or specifically third molar removal. The patients ranged in age from 15 to 80 years (mean age 42.1 years) and 68% were female. The referral delay ranged from 1 day to 6.5 years (average 10 months). The inferior alveolar nerve (IAN) was most frequently injured (28 cases), followed by the lingual nerve (LN) (21 cases). Most nerve injuries were caused during third molar removal (24 cases), followed by implant placement (nine cases) and local anaesthesia injuries (nine cases). Pain symptoms were experienced by 54% of patients suffering IAN injury, compared to 10% of patients with LN injury. Persistent neurosensory disturbances were identified in 60% of patients. While prevention remains the key issue, timely referral seems to be a critical factor for the successful treatment of post-traumatic neuropathy.     

Updated Clinical Considerations for Dental Implant Therapy in Irradiated Head and Neck Cancer Patients

An increasing number of reports indicate successful use of dental implants (DI) during oral rehabilitation for head and neck cancer patients undergoing tumor surgery and radiation therapy. Implant‐supported dentures are a viable option when patients cannot use conventional dentures due to adverse effects of radiation therapy, including oral dryness or fragile mucosa, in addition to compromised anatomy; however, negative effects of radiation, including osteoradionecrosis, are well documented in the literature, and early loss of implants in irradiated bone has been reported. There is currently no consensus concerning DI safety or clinical guidelines for their use in irradiated head and neck cancer patients. It is important for health care professionals to be aware of the multidimensional risk factors for these patients when planning oral rehabilitation with DIs, and to provide optimal treatment options and maximize the overall treatment outcome. This paper reviews and updates the impact of radiotherapy on DI survival and discusses clinical considerations for DI therapy in irradiated head and neck cancer patients.     

Systematic Review of Soft Tissue Alterations and Esthetic Outcomes Following Immediate Implant Placement and Restoration of Single Implants in the Anterior Maxilla

Background: The aim of this review is to assess the outcome of single‐tooth immediate implant placement and restoration (IPR) in the maxillary anterior region, with a particular emphasis on soft tissue and esthetic outcomes. Methods: An electronic search in Medline, EBSCOhost, and Ovid (PubMed) was performed to identify studies that reported on soft tissue outcomes following immediate placement and restoration of implants in the maxillary esthetic region with a mean follow‐up of ≥1 year. Results: Nineteen studies on single implants inserted immediately into fresh extraction sockets and provisionally restored in the maxillary esthetic region were included. Soft tissue changes were found to be acceptable, with most studies reporting mean gingival recession of 0.27 ± 0.38 mm and mean papillary height loss of 0.23 ± 0.27 mm after follow‐up of ≥1 year. Advanced buccal recession (>1 mm) occurred in 11% of cases. Long‐term follow‐up studies (>2 years) reported that the interdental papillae, in particular, showed a tendency to rebound over time. The few studies that reported on patient‐centered outcomes showed a high level of patient satisfaction with the outcomes of IPR treatment. Conclusions: The IPR protocol resulted in generally acceptable soft tissue and esthetic outcomes, with suboptimal results reported in ≈11% of low‐risk cases. Factors such as preoperative tissue biotype or use of a flap or connective tissue graft did not significantly influence soft tissue and esthetic outcomes. Long‐term prospective controlled clinical trials are necessary to identify factors that may influence the esthetic outcomes associated with IPR.     

Care and Aftercare Related to Implant‐Retained Dental Crowns in the Maxillary Aesthetic Region: A 5‐Year Prospective Randomized Clinical Trial

Aim: To prospectively assess surgical and prosthetic care and aftercare related to the placement of implant‐retained dental crowns after local bone augmentation in patients missing one tooth in the maxillary aesthetic region. Methods: Ninety‐three patients were randomly allocated to one of three local augmentation groups: (1) chin bone; (2) chin bone covered by a Bio‐Gide® membrane (Geistlich, Wolhusen, Switzerland); and (3) Bio‐Oss® covered by a Bio‐Gide® membrane. After local augmentation, implant placement (ITI) and fabrication of an implant‐retained dental crown (cemented metal‐ceramic dental crown) was performed. Prosthetic and surgical care and aftercare was scored from the first visit until 5 years after the augmentation of the implant region. Results: The need for care and aftercare was comparable between the local augmentation groups. Three implants were lost (5‐year implant survival rate: 96.7%). Surgical aftercare was needed in 9% of patients and consisted of care related to peri‐implant tissue problems. Prosthetic aftercare was needed more often: all patients needed periodic routine inspections; 63% needed supplemental oral hygiene support; and 16% needed additional prosthetic care, mainly consisting of fabricating new crowns (12%). Conclusion: Placing an implant in the maxillary esthetic region after local bone augmentation is a safe and reliable treatment option not needing much specific aftercare other than periodic preventive routine inspections, routine oral hygiene care, and fabrication of a new crown in one out of every eight to nine patients in 5 years. The method used for augmentation was irrespective of the patients' need for aftercare.     

Success of surgical interventions for direct dental implant-related injuries to the mandibular nerve: a review

To the best of our knowledge there are no guidelines regarding the surgical management of dental implant-related injuries to the mandibular nerve. This review aims to investigate the success of different surgical interventions. Neurosensory injury to the mandibular branch of the trigeminal nerve can occur during administration of local anaesthetic, elevation of the flap, preparation for osteotomy, and placement of the implant. Surgical interventions include extraction of the implant, external decompression, internal neurolysis, excision of a neuroma, neurorrhaphy, nerve grafting, and low-level laser therapy. The following electronic databases were searched: MEDLINE, EMBASE, and the Cochrane Library. Primary outcome measures included patient-reported outcomes such as pain and altered sensation. A total of 185 publications were obtained, of which 21 were included in the qualitative synthesis (2 randomised controlled trials (RCT), 9 controlled cohort studies, and 10 case reports/series). They were all screened in consideration of the exclusion criteria and appraised using the Cochrane risk of bias tool, the Newcastle Ottawa scale, and the modified Newcastle Ottawa scale. Results were triangulated to evaluate their level of agreement. The extraction of dental implants less than 36 hours after injury to the mandibular nerve results in the most successful resolution of neurosensory dysfunction. Various microsurgical techniques have shown less success in obtaining neurosensory recovery than extraction of the implant. However, microsurgery is worthwhile, as it improves neurosensory dysfunction and reduces dysaesthesia in the majority of patients. Direct suturing and external decompression can result in good neurosensory recovery, and nerve grafts are also successful whenever tension-free direct suturing is not possible. Low-level laser therapy has been shown to achieve some neurosensory improvement.     

Epidemiology of traumatised primary teeth in the west-Mediterranean region of Turkey

AIM: To investigate the incidence, aetiological factors and results of dental trauma on primary dentition of the children referred to the Süleyman Demirel University, Department of Paedodontics in a two year period. DESIGN: A retrospective study. PARTICIPANTS: Eighty four children (50 boys and 34 girls) with 159 affected deciduous teeth. RESULTS: The incidence of trauma was slightly higher in boys (59.5%). The age of the children ranged from 9 months to 6 years and the peak ages for trauma were 3 years and 5 years of age in respective genders. Falls were the most frequent cause of traumatic dental injuries (29.7%) and luxations were the most common type of trauma with 135 cases (84.9%). The most frequently performed treatment options were examination and follow up only (37.7%). Half of the cases (51.1%) were referred to our clinic in the first week after the trauma occurred. CONCLUSION: The results of this study suggest that a preventive educational programme should be instituted, directed at parents and teachers at nursery schools, in order to inform them about what to do in dental trauma cases and the importance of immediate attendance for dental care.     

即刻种植与即刻修复在临床应用的研究

目的:评价口腔即刻种植与即刻修复技术的临床应用效果。方法:20例牙列缺损患者行拔牙后即刻种植并于种植后当日前牙区在种植体上部完成临时树脂单冠或联冠修复,后牙区种植体上愈合基台,1周至1个月内行种植体烤瓷冠修复,所有患者均于术后1、3、6、12个月,之后每12个月复查1次。结果:20例患者共植入42颗种植体,平均负荷28个月(最短4个月,最长49个月),除其中2例3枚种植体松动外,其余种植体均获得良好的临床效果,累计存留率为92.86%,患者对修复效果满意。结论:严格掌握适应证,即刻种植与即刻修复可应用于临床,近期效果满意。     

Neurosensory function and implant survival rate following implant placement with nerve transpositioning: a case study

In patients with extensive bone resorption, implant placement posterior to the mental foramen is a problematic surgical procedure. This paper reports the results in 6 patients (aged 20-61) with edentulous areas in the posterior part of the mandible, in whom 26 Nobelpharma implants were placed, including 17 with transposition of the inferior alveolar nerve allowing the use of implant fixtures of at least 10 mm in length. Subsequent neurosensory function, based on British Medical Research Council definitions, and implant survival rate were examined. In all cases, postoperative numbness occurred in the lower lip and mental area. Three years after surgery, while one patient had completely recovered neurosensory function, five patients still experienced partial numbness, although this was not perceived as a problem by those patients. The implant survival rate was 100% approximately three years after surgery. The results suggest that a higher implant survival rate is likely when longer fixtures are used, but this is also more likely to lead to slight long-term neurosensory dysfunction.     

Inferior alveolar nerve function after sagittal split osteotomy of the mandible: correlation with degree of intraoperative nerve encounter and other variables in 496 operations

A total of 1034 patients who had undergone orthognathic surgery were examined after 2 years; 818 had been treated with varying types of mandibular osteotomy such as vertical ramus osteotomy, sagittal split ramus osteotomy, and genioplasty. Neurosensory function in the mental nerve region was assessed by evaluating light touch perception.The incidence of neurosensory deficiency was 216/548 (39%) after sagittal split ramus osteotomy, 26/140 (19%) after extraoral vertical ramus osteotomy, 9/78 (12%) after genioplasty and 60/650 (9%) after intraoral vertical ramus osteotomy. Additional genioplasty increased both the incidence and severity of neurosensory disturbance after intraoral vertical ramus osteotomy but did not significantly influence the neurosensory function after sagittal split ramus osteotomy.The incidences of neurosensory disturbance after mandibular osteotomies in this report correspond well with those previously reported, but the incidence of almost 40% after sagittal split ramus osteotomy must be considered a disquieting drawback of the procedure.     

固定矫治患者牙周临床指标变化的初步研究

目的 :本实验通过观察正畸儿童固定矫治前后牙周临床指标的变化 ,以明确固定矫治器是否会对牙周健康造成影响。方法 :本实验选择 61名 12～ 16岁错牙合畸形的患者 ,3 0名患者为矫治前和矫治后半年 ,3 1名为矫治后半年 ,1年分别观察牙龈指数 (GI)、菌斑指数 (PLI)、软垢指数 (DI)、牙石指数 (CI)等临床牙周指标的改变。结果 :固定矫治器的放置可引起临床牙周指标显著增高 (矫治前后比较 ,P <0 .0 0 1) ,且随放置时间的增长 ,临床牙周指标显著增高 (矫治后半年和 1年比较 ,P <0 .0 0 1)。结论 :固定矫治器的放置可影响牙周组织的健康 ,对接受固定矫治的患者进行规范的口腔卫生宣教是非常重要的     

Vertical distraction osteogenesis of fibula transplants for mandibular reconstruction--a preliminary study.

INTRODUCTION: When reconstructing the mandible after tumour resection with a fibular graft, the mandible is often vertically deficient, making placement of dental implants impossible. PATIENTS: Segmental vertical distraction of the reconstructed mandible was performed in nine patients following tumour surgery between February 1998 and 2001. Their age was 14-65 years (average 46.3); all underwent radiotherapy with a dose of up to 55.6 Gy prior to tumour resection. Mandibular discontinuity was repaired with a microvascular fibular bone graft. All grafts had a vertical bone deficit ranging from 9 to 12 mm when compared with the non-resected part of the mandibles. METHODS: All patients underwent segmental vertical distraction of the transplants. The distraction devices were applied intraorally. Distraction of 1.0 mm/day was performed using a Martin distractor (TRACK 1.5) followed by 12 weeks retention time. RESULTS: The increase of vertical bone height was stable and enabled placement of dental implants without any complications. CONCLUSION: Vertical distraction osteogenesis may become a common procedure in the treatment of alveolar ridge deficiency resulting from transplanting fibulae for mandibular reconstruction following tumour surgery.     

Clinical evaluation of the Biocomp-implant system. Results after 1,3 and 5 years in a general practice

A population of 107 consecutive patients was treated with a new HA-coated, screw-type dental implant (n = 384 implants), the Biocomp implant. Treatment was performed in a general dental practice by one and the same dentist. The implants were utilized for various types of prosthetic constructions, sometimes in challenging conditions with respect to patient selection, jaw bone quantity and quality. A clinical and radiographical evaluation was performed after 1, 3 and 5 years. After 5 years, the chance on implant survival was 87.1% (standard error 3.4%). Implant loss occurred predominantly within the first 1.5 year after implant placement. Particularly short implants, placed in the atrofic maxilla, frequently failed. Biocomp implants that served as abutments for an overdenture in the edentulous mandible or as a single tooth replacement in the upper anterior region had an excellent prognosis.