Computer-assisted flapless implant placement reduces the incidence of surgery-related bacteremia

Objective

Bacteremia—the access of bacterium to the bloodstream—may yield life-threatening complications. The aim of this study was to compare the incidence, duration, and type of bacterium leading to bacteremia with relation to conventional and computer-assisted flapless implant surgery.

Material and methods

A total of 377 implants were placed in 68 edentulous jaws using the conventional (conventional group) or a computer-assisted stereolithographic (SLA) template-guided surgery technique (flapless group). Bacteremia was monitored from pre- and postoperative blood samples.

Results

The duration of the surgical intervention was significantly shorter in the flapless group (p?=?0.3510). Baseline samples were sterile. Following the 15th minute after the placement of the last implant, bacteria were present in 62 and 12 % of the patients in the conventional and flapless groups, respectively (p?<?0.0001; relative risk: 3.05). The differences in the incidence of the bacteremia detected at the baseline and 15 min after the last implant placement were statistically significant in the conventional group (p?=?0.0001). However, no such statistical significance was present in the flapless group. Staphylocccus epidermidis, Bifidobacterium spp., Streptococcus viridans, Corynebacterium spp., and Streptococcus sanguinis were the isolated bacterium.

Conclusions

Irrespective of the utilized technique, bacteremia may occur upon the placement of four to eight implants to an edentulous jaw. The probability of bacteremia for the patients operated with the conventional technique is, however, 3.05 greater than those operated with the flapless technique.

Clinical relevance

Flapless implant placement reduces the incidence of surgery-related bacteremia and, therefore, may be beneficial to patients at risk.     

Oral squamous cell carcinoma in the vicinity of dental implants

Objectives

The study at hand presents a cohort of patients treated for carcinomas in the vicinity of dental implants for identification of potential risk factors.

Materials and methods

The retrospective analysis covers patients treated for peri-implant carcinoma at our department between 1995 and 2011. An additional literature search focused likewise on peri-implant carcinomas. Obtained articles were screened for relevant risk factors and discussed in relation to our patient cohort.

Results

Fifteen patients were treated for peri-implant carcinoma. Six reported ongoing alcohol/tobacco consumption. Nine had a previously reported carcinoma of whom six had received radiotherapy after surgery. Time from implant placement until carcinoma diagnosis was 53.4 months on average. The literature search revealed 25 patients with peri-implant carcinoma and one with a sarcoma. Eight patients reported alcohol/tobacco consumption. Most patients exhibited risk factors for possible malignant transformation: previous carcinoma (n?=?12), lichen (n?=?4), irradiation (n?=?3), and leukoplakia (n?=?3). The average time until diagnosis was 51.6 months.

Conclusions

Smoking, alcohol consumption, and the history of previous carcinoma characterize patients at risk for a peri-implant carcinoma. A balanced gender ratio might point at a higher risk for woman and additional risk factors promoting carcinogenesis apart from tobacco and alcohol consumption, a novel finding that has to be proven by larger patient counts.

Clinical relevance

The incidence of carcinomas next to dental implants is low but may attain clinical relevance with raising implant figures worldwide. Patients at risk potentially profit from individualized recall intervals and careful evaluation.     

Implant migration into maxillary sinus: description of two asymptomatic cases

Background

Rehabilitation of edentulous jaws with dental implants has become a usual practice around the world. A very low incidence of complications is associated with this therapy. One of them is migration of dental implants into maxillary sinus. Foreign bodies inside maxillary sinus should be removed because they can cause sinusitis, but if any symptoms are present, preservation alone can be indicated. Implant removal and bone reconstruction on the same procedure reduce treatment time and allow rehabilitation with implant-supported prosthesis.

Methods

In the present study, we report two cases of dental implants displaced into maxillary sinus that receive different treatment.

Results

In one of them, implant removal and sinus lift were carried out on same procedure while on the other preservation alone was advocated.

Conclusion

Both treatment modalities treatments allowed installation of implant-supported prosthesis.     

Biomimetic treatment on dental implants for short-term bone regeneration

Objectives

The main purpose of this work was to assess the short-term bone regenerative potential of new osteoconductive implants. The novelty of the study lies in the analysis of the effectiveness of a novel two-step treatment which combines shot-blasting with a thermo-chemical treatment, at very short times after implant placement in a minipig model.

Materials and methods

Three hundred twenty implants with four different surface treatments, namely bioactivated surfaces, micro-rough grit-blasted, micro-rough acid-etched and smooth as-machined titanium implants were placed into the bone of 20 minipigs. The percent of bone-to-implant contact was determined 3 days, 1, 2, 3 and 10 weeks after implant placement by histomorphometric analysis. Surface composition, topography and wettability of the implant specimens were analysed.

Results

The combination of shot-blasting and thermo-chemical treatment accelerated bone regeneration at early stages in comparison with all other treatments between day 3 and week 3 (p?<?0.05). The value of osseointegration attained at week 2 was maintained until the end of the experiment without any significant changes (percent direct contact?≈?85 %). This was mostly attributed to the ability of these implants to form in vivo a layer of apatitic mineral that coated the implant and could rapidly stimulate bone nucleation and growth from the implant surface.

Conclusions

The surface quality resulting from this treatment on cpTi provided dental implants with a unique ability of rapid bone regeneration and osseointegration.

Clinical relevance

This treatment represents a step forward in the direction of reducing the time prior to implant loading.     

Dental risk factors for osteonecrosis of the jaws: a CONDOR case–control study

Background

Reports of osteonecrosis of the jaw (ONJ) have associated this lesion to treatment with bisphosphonates (BPs) and dental procedures. In this study, we investigated the association of specific dental diagnoses and procedures with ONJ among patients with past BP use.

Methods

Dentists from three practice-based research networks provided ONJ cases and controls (1:3). Data gathered from patients and dental offices with two respective standard questionnaires included demographic, medical, pharmaceutical, and dental information. Diagnoses and procedures up to 3 years prior to ONJ (prior to interview for controls) were analyzed within risk strata, defined by BP use and cancer status, using interaction terms within conditional logistic regression models.

Results

We enrolled 191 ONJ cases and 573 controls from 119 dental offices. Among participants who had used only oral BP, extraction was the only dental risk factor for ONJ (odds ratio (OR)?=?12, p?=?0.01). Suppuration was also more prevalent in cases (18 %) than in controls (9 %), but not statistically significant (OR?=?9, p?=?0.06). Among participants who had not used either oral or IV BP (a majority of whom received radiation therapy to the head and neck), suppuration was the only dental risk factor for ONJ (prevalence?=?34 % for cases and 8 % for controls; OR?=?7, p?=?0.01). The prevalence of extractions in this group was also higher, but not statistically significant (44 vs 10 %; OR?=?3). Limited power precludes definitive findings among participants exposed to IV BP.

Conclusions

Among patients taking oral BP, extraction was the only dental procedure associated with subsequent ONJ development

Clinical relevance

Results of this study suggest that routine dental procedures are not associated with development of ONJ in patients exposed to BPs.     

Implant rehabilitation in patients with oral lichen planus: an overview

Objectives

Implant rehabilitation in oral lichen planus (OLP) is a major challenge for clinicians and patients. There is limited scientific evidence, primarily case reports and small case series. We conducted a literature review of data on the effectiveness and safety of implant rehabilitation in OLP patients.

Material and methods

We searched MEDLINE, Embase and Cochrane databases for articles on implant placement in OLP patients (searches from 1980 to 2011).

Results

Eight studies (41 OLP patients rehabilitated with 135 implants) met the inclusion criteria. Survival rate of implants was 94.8% over a mean follow-up of 56.5?months.

Conclusions

There is very limited evidence on the safety and benefits of implant placement in OLP patients. Implant loss appears not to be directly related to OLP, but linked to factors such as parafunctions, poor bone quality and marginal mandibular resection. The benefits and harms of using implants in people with OLP require thorough evaluation in properly designed randomised, controlled studies.

Clinical relevance

OLP is not an absolute contraindication for implant insertion and there is no increased risk of failure. Implants should be positioned only if mucosal signs and symptoms are in the remission phase. A careful oral hygiene and frequent follow-up are the main recommendations in OLP patients rehabilitated with implants.     

The relationship between implant stability and bone health markers in post-menopausal women with bisphosphonate exposure

Objectives

The authors assessed the relationship between implant stability and bone turnover markers in patients with and without a history of bisphosphonate (BP) exposure for treatment of osteopenia/osteoporosis.

Materials and methods

One dental implant site was evaluated in 58 post-menopausal women with a spectrum of bone health in a "best practice" prospective cohort study. Each site had a previous or simultaneous bone augmentation procedure. BP exposure at enrollment was categorized as "never" or "past/current" exposure. Implant stability was assessed by resonance frequency analysis (RFA ISQ) at surgery and 8 weeks post-implant. Bone turnover markers, C-telopeptide collagen crosslinks (sCTX) and procollagen ?1 N-terminal telopeptide (P1NP), were measured pre-treatment, 1, and 8 weeks following implant surgery.

Results

Mean age was 62.4?±?6.8 years; 66 % were osteopenic/osteoporotic. Average RFA ISQ at placement for all participants was 63.5?±?11.3, at 8 weeks post-surgery 74.2?±?9.4 (p?<?0.01). Among "past/current" BP users, there was a significant negative correlation between RFA ISQ values at 8 weeks post-implant placement and sCTX and P1NP values at 1 week (ρ?=??.65 and ρ?=??.55, respectively; p?<?0.01) and 8 weeks (ρ?=??.64 and ρ?=??.52, respectively; p?<?0.05).

Conclusion

RFA ISQ values increased between implant placement and 8 weeks post-surgery demonstrating successful osseointegration. Lower bone turnover was associated with better implant stability among patients with a history of BP exposure.

Clinical relevance

Further investigation of the relationship between BP exposure and implant stability is warranted in a larger population, as results may strongly impact on clinical practice decisions.     

Accuracy of peri-implant bone thickness and validity of assessing bone augmentation material using cone beam computed tomography

Objectives

The aim of this study was to evaluate the accuracy of measuring bone thickness surrounding dental implants and the reliability of assessing existence and completion of osseous integration of augmentation material using a cone beam computed tomography (CBCT) system.

Materials and methods

In jaws of foxhounds, artificial defects were regenerated by guided bone regeneration and then dental implants were placed. After putting down the dogs, the jaws were separated from the bodies and exposed in a CBCT system. The bone thickness was measured on both buccal and oral sides of the implants at different levels. Every examiner evaluated existence and integration of bone augmentation materials (BAM) and the completeness of marginal implant covering. The same measurements and evaluations were performed at digital images of the corresponding histological sections.

Results

The mean and the standard deviation of the differences between radiological and histological measurements of peri-implant bone thickness were ?0.22 mm and 0.77 mm, respectively. Sensitivity and specificity were 0.77 and 0.60 for existence of BAM, 0.59 and 0.74 for completed integration, and 0.39 and 0.71 for full covering of the implant surface.

Conclusions

The present study indicates that the PaX Duo3D® CBCT system allows measurements of peri-implant bone thickness at an accuracy of half a millimeter, and—within limits—assessing the existence and integration of BAM. It is not possible to evaluate whether the implant is covered completely by hard tissue.

Clinical relevance

Peri-implant bone thickness is a key factor for obtaining initial implant stability. The accuracy of its measurement has clinical impact. Radiological assessment of existence and integration of BAM would be of great benefit to the evaluation of augmentation procedures.     

Implant survival and patient satisfaction in completely edentulous patients with immediate placement of implants: a retrospective study

Background

This study evaluated full-arch rehabilitation of patients with immediately placed implants in terms of the cumulative implant survival rate, risk factors for implant failure, and patient satisfaction.

Methods

Time-to-event data of 52 completely edentulous jaws (370 implants) were collected using retrospective clinical chart review for the time period from 2008 to 2014. A conventional two stage approach for surgery was adopted to immediately placed implants in the maxilla, and immediate placement and immediate loading protocols for the mandible were followed. The study calculated the 7-year cumulative survival rates (CSR), and a Bayesian hierarchical Cox proportional hazard model was used to measure the effect of covariates. Patient satisfaction on chewing ability, esthetic appearance, and overall satisfaction was also measured with a face-to-face interview survey.

Results

Of the total 370 implants, 194 were immediate placement. Two delayed loading maxillary implants failed within the first year, and another one failed in the second year of loading. Two failures were recorded in the first year and one in seven years for the immediate loading mandibular implants. The 1-, 5-, and 7-year CSR of the 370 implants were 0.989 (0.979, 1.000), 0.986 (0.975, 0.998), and 0.978 (0.957, 0.999), respectively. Only the length of the implant affected implant failure (p?<?0.05); other patient characteristics, systemic diseases, implant diameter, immediate loading, and immediate placement, did not have an effect on implant failure rates. Patients reported a high degree of satisfaction regardless of their age group or length of the observation period.

Conclusions

Immediately placed implant had CSR as high as delayed placed implants, and 7-year CSRs of immediate loading were not significantly different from delayed loading. The procedure also had a high degree of chewing ability, esthetic appearance, and overall satisfaction. The study results suggested that the clinical procedures applied in this study to completely edentulous patients were acceptable rehabilitation procedures.

     

Should endodontists place dental implants? A national survey of general dentists

Introduction

The purpose of this study was to assess whether general dentists support the placement of dental implants by endodontists.

Methods

A 29-item written survey was developed and mailed to 1,500 randomly selected practicing general dentists within the United States to assess whether respondents supported implant placement by endodontists and whether they would refer patients to endodontists for implant placement. Univariate, bivariate, and logistic regression analyses were performed.

Results

Three hundred sixty-six subjects completed surveys. Sixty-six percent of respondents opposed endodontists placing implants, and 73% indicated they would not refer patients to an endodontist for implant placement. The following characteristics were associated with respondents who support implant placement (P < .05): yes, willing to refer to an endodontist for implant placement; believes other specialists would support endodontists placing implants; never or sometimes refers patients for molar root canal treatment; and plans to retire in 5 years.

Conclusions

The majority of respondents did not support implant placement by endodontists. As the demand for implant therapy continues to grow, it may be necessary to increase the number of practitioners who place dental implants. However, general dentists’ and specialists’ attitudes should be further assessed before modifying the scope of endodontic practice to include implant placement.     

Retrospective Clinical Study of Marginal Bone Level Changes with Two Different Screw-Implant Types: Comparison Between Tissue Level (TE) and Bone Level (BL) Implant

Aim

The objective of this retrospective cohort study was to compare the amount of marginal bone loss (MBL) in a bone-level and a soft-tissue-level implant system, both of which have similar intra-bony shape and surface composition. A subgroup analysis was done to compare the amount of MBL of each implant type in relation to the different vertical placement within the respective groups of implants.

Materials and Methods

Records of all patients who underwent implantation for replacement of teeth using comparable bone level (BL) and soft tissue level implants (TE) from 1st January 2006 to 31st December 2009 were scrutinized. Initial depth of implant placement (IDIP) was measured for all implants. Marginal bone loss was measured in patients whose records were available at time point corresponding to 12, 24 and 36 months post insertion.

Results

Out of a total of 384 implants, 337 implants were included for study. The mean MBL for the BL implants were 0.3, 0.38, 0.48 and for TE implant were 0.6, 0.54 and 0.93 for time periods 12, 24 and 36 months respectively. Although there was no statistically significant difference between the two groups at time periods at 6–12 months, in later time periods, there was a slightly greater amount of MBL around TE implants as compared to BL implants (p < 0.001). When comparing the IDIP and MBL in the same implant type, there was a statistically significant (p < 0.001) positive correlation between the depth of implant placement and the amount of MBL, with deeper placed implants having more bone loss.

Conclusion

Within the limitations of this retrospective cohort study design, one can conclude that BL implants had statistically significant lesser MBL as compared to TE in time periods above 12 months. Although the difference is statistically significant, the difference may not be clinically significant. The IDIP had an influence on the amount of MBL, with deeper placed implants and screw structure of the implant placed below the bone, having more MBL in the period of study.     

Orthodontic treatment of patients medicated with bisphosphonates—a clinical case report

Introduction

Bisphosphonates (BP) are an established medication, e.g., for the prevention/therapy of osteoporosis. The effects of the changed bone metabolism for orthodontic treatments are unknown.

Case report

A 66-year-old woman underwent a total oral rehabilitation. The therapy included (1) tooth extractions, (2) periodontal treatment, (3) insertion of dental implants, (4) provisional implant restorations, (5) orthodontic treatment, and (6) definite implant restorations. The orthodontic tooth movements were in- and retrusion of the upper frontal teeth, intrusion of the lower front teeth, using the dental implants as skeletal anchorage. After implant insertion and one month before beginning the orthodontic treatment, osteoporosis was diagnosed in this patient and, without notification to our facility, BP treatment was initiated by her general practitioner (alendronate oral, 70 mg/week), with an overall duration of intake of 7 months. After 13 months, the orthodontic treatment was successfully accomplished; however enlarged periodontal gaps, sclerotic bone areas, and mild apical root resorptions of the upper frontal teeth were found in this patient.

Conclusion

Currently, there are no recommendations for orthodontic patients undergoing BP therapy. Orthodontic tooth movement in this low-risk patient with a short duration of intake and a low-dose BP medication was possible. Because of the reduced bone metabolism and the higher amount of side effects, the treatment should be performed with extremely light forces and frequent monitoring.     

Mikrobiologische Untersuchung zur Ermittlung des Erfolges der Sofortimplantation im parodontal geschädigten Gebiss

Aim

The aim of the present study was to investigate the prevalence of periodontal marker organisms and specific interleukin-1 (IL-1) gene polymorphisms (which show a close association with periodontitis) and their effect on the success of immediate implant placement postextraction in the patient with periodontal disease.

Patients and methods

A group of 59 patients (22 men and 37 women aged 20–81 years, median age 55 years, 18 smokers) with chronic adult periodontitis participated in the study which included a 1-year observation period postoperatively. Prior to tooth extraction two DNA samples were obtained for the microbiological diagnosis of five anaerobic gram-negative pathogens (Haemophilus actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensis, Prevotella intermedia sensu stricto, Treponema denticola) and to identify the IL-1 gene polymorphisms. Patients were treated with a total of 95 immediate dental implants (26 Ankylos/Friadent and 69 Camlog Root-Line/Camlog Biotechnologies) placed into extraction sites, 78 of which were loaded immediately. After 1 year four failures were observed; all of these patients were smokers.

Results

None of these patients showed a positive IL-1 genotype; periodontal marker organisms were only found in one patient. No significant difference was seen in the microbiological pathogens between smokers and nonsmokers. Of 59 patients, 23 (39%) tested positive for IL-1 genotype polymorphism. Smoking was shown to increase the risk of implant failure. No association was observed between failures and the IL-1 gene polymorphisms or pathogens.

Conclusion

In conclusion, our study shows that periodontally infected sites do not seem to be a contraindication for immediate implantation.     

Kieferknochennekrosen als mögliche unerwünschte Wirkung von Bisphosphonaten

Background

Bisphosphonates are widely used in the treatment of cancer patients with hypercalcemia and bone metastases or in osteoporosis therapy. Current reports have focused on therapy-resistant osteonecrosis of the jaws as a possible side effect of bisphosphonates. Official German drug committees have recently warned about the possibility of these side effects in the publication organs Deutsches Ärzteblatt and Deutsche Apotheker Zeitung.

Case reports

So far we have had experience with seven patients showing therapy-resistant osteonecrosis of the mandible under bisphosphonate medication. The presentation of these cases is intended to call attention to this clinically important side effect of bisphosphonate medication.     

Computer-aided flapless implant surgery and immediate loading. A technical note

Purpose

The aim of the present technical note was to describe a prosthetic technique developed to increase the predictability of immediately loaded implants supporting a fixed prosthesis after computer-aided template-guided flapless implant placement.

Methods

During a 2-year period, eight patients presenting partial edentulism underwent computer-aided template-guided implant placement. The presented technique was used during the prosthetic procedures to directly transfer the data obtained with the facebow to the surgical environment, allowing for accurate repositioning of the temporary prosthesis on the implants as previously planned with the digital software.

Results

A total of 78 dental implants were immediately loaded with an implant-supported fixed prosthesis after flapless template-guided implant placement. A survival and success rate of 100 % was reported after a mean follow-up of 1 year from the prosthetic loading. Neither major complications nor dropouts were observed during the healing time. From both clinical and radiological evaluations, implants appeared stable with no signs of soft tissue inflammation or infection and no evidence of pathological peri-implant bone resorption.

Conclusions

The proposed technique associated with computer-aided implant placement and immediate loading protocol provided a high implant and prosthetic survival and success rate. No complications were reported during the recalls, suggesting predictability and reliability of the present technique over a short-term period.

     

Influence of cortical bone anchorage on the primary stability of dental implants

Purpose

This retrospective chart review study assessed patient records to determine implant insertion torque (IT) and implant stability quotient (ISQ) values during implant placement to evaluate the correlation with cortical bone anchorage (mono- or bicortical).

Methods

Primary stability data (IT during implant placement surgery and ISQ values immediately after implant placement) and cone beam computed tomography of 33 patients (165 implants) were assessed. Patients were divided into the following groups: G1, implants with apical cortical bone contact; G2, implants with bicortical bone contact (apical and cervical regions); and G3, implants with cervical cortical bone contact.

Results

Sixty-eight implants were excluded due to cortical bone contact on regions other than implant apical or cervical. Ninety-seven implants were therefore assessed for this study. No implant failure was found after a mean 70.42-month follow-up time. Implants with bicortical anchorage (G2) showed higher IT (64.1 Ncm) during implant placement and higher ISQ values (76) (p?<?0.05). Monocortical implants (G1, apical, and G3, cervical) showed similar IT (G1 52.3 and G3 54.3) and ISQ values (G1 71.9 and G3 73) (p?>?0.05). No correlation (Pearson correlation coefficient) was found between the two stability measurement devices for the different cortical bone anchorages that were analyzed (G1 0.190, G2 0.039, and G3 ??0.027) (p?>?0.05).

Conclusions

Insertion torque values and implant stability quotients were influenced by cortical bone contact. No significant correlation was found between IT and ISQ values—higher insertion torque values do not necessarily lead to higher implant stability quotients.

     

Implants in bone: Part I. A current overview about tissue response,surface modifications and future perspectives

Purpose

The aim of study paper is to present an overview of osseointegration of dental implants, focusing on tissue response, surface modifications and future perspective.

Discussion

Great progress has been made over the decades in the understanding of osseous peri-implant healing of dental implants, leading to the development of new implant materials and surfaces. However, failures and losses of implants are an indicator that there is room for improvement. Of particular importance is the understanding of the biological interaction between the implant and its surrounding bone.

Conclusion

The survival rates of dental implants in bone of over 90 % after 10 years show that they are an effective and well-established therapy option. However, new implant materials and surface modifications may be able to improve osseointegration of medical implants especially when the wound healing is compromised. Advanced techniques of evaluation are necessary to understand and validate osseointegration in these cases. An overview regarding the current state of the art in experimental evaluation of osseointegration of implants and implant material modifications will be given in Part II.     

A retrospective study on related factors affecting the survival rate of dental implants

PURPOSE

The aim of this retrospective study is to analyze the relationship between local factors and survival rate of dental implant which had been installed and restored in Seoul Veterans Hospital dental center for past 10 years. And when the relationship is found out, it could be helpful to predict the prognosis of dental implants.

MATERIALS AND METHODS

A retrospective study of patients receiving root-shaped screw-type dental implants placed from January 2000 to December 2009 was conducted. 6385 implants were placed in 3755 patients. The following data were collected from the dental records and radiographs: patient''s age, gender, implant type and surface, length, diameter, location of implant placement, bone quality, prosthesis type. The correlations between these data and survival rate were analyzed. Statistical analysis was performed with the use of Kaplan-Meier analysis, Chi-square test and odds ratio.

RESULTS

In all, 6385 implants were placed in 3755 patients (3120 male, 635 female; mean age 65 ± 10.58 years). 108 implants failed and the cumulative survival rate was 96.33%. There were significant differences in age, implant type and surface, length, location and prosthesis type (P<.05). No significant differences were found in relation to the following factors: gender, diameter and bone quality (P>.05).

CONCLUSION

Related factors such as age, implant type, length, location and prosthesis type had a significant effect on the implant survival.     

Bone mineral density measurements performed by cone-beam computed tomography in the bisphosphonate-related osteonecrosis-affected jaw

Objectives

The aims of this study were to determine the bone mineral density (BMD) in bisphosphonate-related osteonecrosis of the jaw (BRONJ) by cone-beam computed tomography (CBCT) measurements and to correlate these measurements with the current stages recommended by the American Association of Oral and Maxillofacial Surgeons (AAOMS).

Methods

Bone mineral density measurements of various areas in 24 bisphosphonate-related osteonecrosis (BRON) jaws were evaluated by CBCT. Another 24 age- and sex-matched patients without any bone pathologies served as the control group. Data acquisition was highly standardized to ensure maximum reliability in the comparisons of BMD measurements by CBCT.

Results

Compared with the control group, the bisphosphonate patients had significantly higher (p????0.01) BMDs in the non-affected jaw areas ipsilateral and contralateral to the BRON within the maxilla and mandible. The highest BMDs within the BRON jaws were observed in the BRON-adjacent areas relative to the non-affected ipsilateral and contralateral areas. Regarding the correlation with the AAOMS stages, the BMDs of the evaluated areas of BRONJ showed no significant differences (p????0.05) between the stages.

Conclusions

Bisphosphonate-related bone pathologies can be detected by CBCT and are associated with increased BMDs, not only in clinically obvious BRONJ areas, but also in clinically unapparent areas, suggesting a subclinical general osteosclerosis of the jaw. The data transferability to other CBCT devices needs to be further elucidated and compared with multislice CT.     

Immediate loading of overdentures: systematic review

Introduction

The goal of implant treatment is the formation of a direct bone–implant interface contact.

Purpose

This study aimed to evaluate the possibilities of immediate loading treatment for edentulous patients rehabilitated with mandibular and maxillary overdentures.

Material and methods

A literature review using the PubMed and BIREME databases between the periods of 1977 and 2011 was performed.

Results

From an initial yield of 218 titles, 78 articles were selected for text analysis, finally resulting in 23 studies (16 prospective, 6 prospective randomized, and 1 prospective multicenter) that met the inclusion criteria.

Conclusion

The immediate loading protocol through which the implants are subjected to occlusal function immediately after their placement was introduced to overcome this limitation.