Narrow‐ and regular‐diameter implants in the posterior region of the jaws to support single crowns: A 3‐year split‐mouth randomized clinical trial

Objectives

The objective of this 3‐year split‐mouth randomized controlled clinical study was to compare narrow‐diameter implants (NDIs) to regular‐diameter implants (RDIs) in the posterior region of the jaws (premolars and molars) in regards to (i) the marginal bone level (MBL) and (ii) implant and prosthesis survival and success rates.

Material and Methods

A total of 22 patients were included in the study. Each patient received at least one implant of each diameter (Ø3.3 and Ø4.1 mm), placed either in the maxilla or mandible to support single crowns. A total 44 implants (22 NDIs and 22 RDIs) were placed and included in the study. Twenty‐one implants were placed in the premolar, whereas 23 were placed in molar areas. Radiographic evaluations to access the MBL were performed immediately after implant placement, 1 and 3 years after implant loading. Peri‐implant clinical variables including probing pocket depth (PPD) and bleeding on probing (BoP) were obtained after crown delivery, 1 and 3 years after loading. Furthermore, the survival and success rates of the implants and prosthesis were also evaluated.

Results

Twenty patients were able to complete the study. There was no statistically significant difference regarding MBL between groups at implant placement (p = .084), 1‐year (p = .794) and 3‐year (p = .598) time intervals. The mean peri‐implant bone loss at 3‐year follow‐up was ?0.58 ± 0.39 mm (95% CI: ?0.751 to ?0.409) and ?0.53 ± 0.46 mm (95% CI: ?0.731 to ?0.329) for NDIs and RDIs, respectively. BoP was present at 15% and 10% of NDIs and RDIs, respectively, at 3‐year follow‐up. PPD >5 mm was observed in 5% and 0% of the implants of NDIs and RDIs, respectively, at 3‐year follow‐up. At the 3‐year examination, the implant success rates were in the NDIs and RDIs sites, respectively, 95% and 100%. The corresponding values for prosthesis success rates were 90% for NDIs and 95% for RDIs.

Conclusion

The present study demonstrated that NDIs placed to support single crowns in the posterior region did not differ to RDIs in regards to MBL, implant survival, and success rates.     

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.     

Clinical outcomes and cost effectiveness of computer‐guided versus conventional implant‐retained hybrid prostheses: A long‐term retrospective analysis of treatment protocols

1 Background

Computer‐guided systems were developed to facilitate implant placement at optimal positions in relation to the future prosthesis. However, the time, cost and, technique sensitivity involved with computer‐guided surgery impedes its routine practice. The aim of this study is to evaluate survival rates and complications associated with computer‐guided versus conventional implant placement in implant‐retained hybrid prostheses. Furthermore, long‐term economic efficiency of this approach was assessed.

2 Methods

Patients were stratified according to implant placement protocol into a test group, using computer‐guided placement, and a control group, using traditional placement. Calibrated radiographs were used to measure bone loss around implants. Furthermore, the costs of the initial treatment and prosthetic complications, if any, were standardized and analyzed.

3 Results

Forty‐five patients (149 implants in the test group and 111 implants in the control group) with a minimum follow‐up of 5 years, and a mean follow‐up of 9.6 years, were included in the study. While no significant difference was found between both groups in terms of biologic and technical complications, lower incidence of implant loss was observed in the test group (P < 0.001). A statistically significant difference in favor of the non‐guided implant placement group was found for the initial cost (P < 0.05) but not for the prosthetic complications and total cost (P > 0.05).

4 Conclusions

Computer‐guided implant placement for an implant‐supported hybrid prosthesis is a valid, reliable alternative to the traditional approach for implant placement and immediate loading. Computer‐guided implant placement showed higher implant survival rates and comparable long‐term cost to non‐guided implant placement.     

Long‐term Schneiderian membrane thickness changes following zygomatic implant placement: A retrospective radiographic analysis using cone beam computed tomography

Objectives

The purpose of this retrospective study was to evaluate the long‐term changes in the thickness of Schneiderian membranes after zygomatic implant placement using cone beam computed tomography (CBCT).

Material and methods

Twenty‐five consecutive patients were included in this study. All the patients underwent bilateral zygomatic implant placement. Schneiderian membrane thickness (SMT) in 49 maxillary sinuses (one sinus was not included because of early loss of the zygomatic implants) was measured using CBCT before and at least 1 year after zygomatic implant placement. Ostium patency of each sinus was also evaluated and recorded.

Results

In total, 84 zygomatic implants and 30 regular implants were placed in included patients. Two unilateral maxillary zygomatic implants in one patient were removed 2 months after implant placement. The SMT increased from 1.03 mm (inter‐quartile range: 1.57 mm) to 1.33 mm (inter‐quartile range: 1.98 mm) after a median follow‐up time of 23.00 months (inter‐quartile range: 14 months), and the difference was statistically significant. Before zygomatic implant insertion, 24.5% (12/49) of sinuses had SMT greater than 2 mm, whereas this value was 28.6% (14/49) after zygomatic implant placement. The percentage of sinuses observed with ostium patency also increased from 2.0% (1/49) to 12.2% (6/49).

Conclusions

Chronic Schneiderian membrane thickening could result from zygomatic implant insertion. Intensive postoperative care and clinical and radiographic monitoring are recommended after zygomatic implant placement.     

Five‐year outcomes of a randomized clinical trial comparing bone‐level implants with either submerged or transmucosal healing

Aim

To evaluate the long‐term hard and soft tissue peri‐implant tissue stability of bone‐level implants using a different implant placement protocol (submerged versus transmucosal).

Materials and methods

This study was partly a subset analysis of a multicentre study where in 40 patients, a single bone‐level implant with platform switching and a conical implant‐abutment interface was placed either submerged or transmucosal in non‐molar sites. Changes in the peri‐implant tissues between implant placement and 5 years were assessed clinically and radiologically. Patient‐related outcomes were also recorded.

Results

Thirty patients completed the 5‐year follow‐up. Implant survival rate was 100%. The mean radiographic changes in crestal bone levels between baseline and 5 years were 0.59 (0.92) mm and 0.78 (1.03) mm for the submerged and the transmucosal groups, respectively. No statistical significant differences were found between the groups for any of the investigated variables. Peri‐implantitis, defined as changes in the level of crestal bone of ≥2 mm together with bleeding on probing, was only diagnosed in one patient. Patients in both groups were highly satisfied with the treatment received.

Conclusions

Bone‐level implants with submerged or transmucosal healing protocols demonstrated similar outcomes after 5 years. Both protocols yielded optimal clinical and radiographic results when bone‐level implants were placed in non‐molar positions for single tooth replacement.     

The evaluation of peri‐implant sulcus fluid osteocalcin,osteopontin, and osteonectin levels in peri‐implant diseases

1 Background

Peri‐implant mucositis is an inflammation of the soft tissues surrounding an implant. Peri‐implantitis refers to a process characterized by peri‐implant bone loss along with an inflammation of the soft tissues. Osteocalcin, osteopontin, and osteonectin proteins are related to bone remodeling. The aim of the present study was to investigate peri‐implant sulcus fluid (PISF) osteocalcin, osteopontin, and osteonectin levels in peri‐implant mucositis and peri‐implantitis.

2 Methods

Fifty‐two implants with peri‐implantitis, 46 implants with peri‐implant mucositis, and 47 control implants were included in the study. Clinical parameters including probing depth, modified sulcus bleeding index and modified plaque index were recorded. PISF osteocalcin, osteopontin, and osteonectin levels were analyzed by ELISA kits.

3 Results

There were no significant differences in PISF osteocalcin, osteopontin, and osteonectin total amounts between healthy controls, peri‐implant mucositis and peri‐implantitis groups (P > 0.05). Probing depths were not correlated with PISF osteocalcin, osteopontin, and osteonectin levels in the study groups (P > 0.05).

4 Conclusions

Soft tissue inflammation around dental implants does not cause a change in osteocalcin, osteopontin, and osteonectin levels in PISF. Also, peri‐implantitis does not seem to give rise to an increase in PISF levels of osteocalcin, osteopontin, and osteonectin.     

The influence of different soft‐tissue grafting procedures at single implant placement on esthetics: A randomized controlled trial

1 Background

Soft‐tissue grafting to thicken the soft tissue around dental implants was proposed to ameliorate the esthetic outcome. Traditionally, connective tissue is used as a grafting material, but a xenogeneic collagen matrix was introduced as an alternative to reduce patient morbidity.

2 Methods

A total of 60 patients randomly received either no graft (n = 20, NG group), a connective tissue graft (n = 20, CTG group), or a xenogeneic collagen matrix (n = 20, XCM group) when an implant was placed in a preserved alveolar ridge. Changes in mid‐buccal mucosal level (MBML) at 1 (T₁) and 12 (T₁₂) months after final implant crown placement were compared to the pre‐extraction level. Additionally, esthetics, marginal bone level, clinical peri‐implant parameters, and patient satisfaction were assessed.

3 Results

At T₁₂, mean changes in MBML were –0.48 ± 1.5 mm, –0.04 ± 1.1 mm, and –0.17 ± 1.3 mm in the NG, CTG, and XCM groups (P = 0.56), respectively. Regarding the other outcome variables, no significant intergroup differences were observed.

4 Conclusions

Soft‐tissue grafting at single implant placement in preserved alveolar ridges does not result in a better esthetic outcome or in better peri‐implant health and should not be considered as a standard procedure.     

Immediate Placement of Dental Implants in the Esthetic Zone: A Systematic Review and Pooled Analysis

Background: Research interest on immediate placement of dental implants has shifted from implant survival toward optimal preservation of soft and hard tissues. The aim of this study is to systematically assess the condition of implant survival, peri‐implant hard and soft tissue changes, esthetic outcome, and patient satisfaction of immediately placed single‐tooth implants in the esthetic zone. Methods: MEDLINE, EMBASE, and CENTRAL databases were searched for publications up to June 2013. Studies reporting on implant survival, changes in hard and soft peri‐implant tissues, esthetic outcome, and patient satisfaction were considered. A pooled analysis was performed to identify factors associated with survival and peri‐implant tissue changes after immediate implant placement. Results: Thirty‐four studies were considered eligible. Immediate placement of single‐tooth implants in the esthetic zone was accompanied by excellent 1‐year implant survival (97.1%, 95% confidence interval [CI]: 0.958 to 0.980). Mean marginal peri‐implant bone loss was 0.81 ± 0.48 mm, mean loss of interproximal peri‐implant mucosa level was 0.38 ± 0.23 mm, and mean loss of peri‐implant midfacial mucosa level was 0.54 ± 0.39 mm. Regression analysis revealed that delayed provisionalization (odds ratio [OR] 58.03, 95% CI: 8.05 to 418.41, P <0.000), use of a flap (OR 19.87, 95% CI: 10.21 to 38.66, P <0.000), and use of a connective tissue graft (OR 4.56, 95% CI: 1.72 to 12.08, P <0.002) were associated with marginal peri‐implant bone‐level change >0.50 mm. Because of underreporting, esthetic results and patient outcome did not allow for reliable analysis. Conclusion: Immediate placement with immediate provisionalization of dental implants in the esthetic zone results in excellent short‐term treatment outcome in terms of implant survival and minimal change of peri‐implant soft and hard tissue dimensions.     

In vitro evaluation of controlled‐release 14% doxycycline gel for decontamination of machined and sandblasted acid‐etched implants

1 Background

Peri‐implant infections are associated with the establishment and maturation of a bacterial biofilm characterized by a predominance of Gram‐negative fusiform anaerobic species. The decontamination of implant surfaces is then crucial for a successful peri‐implant therapy.

2 Methods

Twenty‐one smooth and 21 rough implants, divided into four groups according to surface and treatment modality, were contaminated with Streptococcus sanguinis and then placed in an incubator with the atmosphere of 5% CO2 at 37°C for 24 hours to allow the bacteria to grow. After 24 hours, the test groups were treated with controlled release 14% doxycycline gel injecting the gel circumferentially over the surface of the implant for 3 minutes, while the control groups were irrigated with sterile saline for 1 minute. The implants were then vortexed into triptych soy broth to allow the bacteria to detach from the surface, diluted 1:100 and plated. Colony forming units (CFU) were counted 48 hours after incubation.

3 Results

The use of a 14% doxycycline gel minimized CFU counts compared to control groups, with the difference being statistically significant (P < 0.05). The reduction of CFUs in the smooth test group is more marked than in the rough test group, but the difference doesn't reach statistically significance (P = 0.215).

4 Conclusions

The use of 14% doxycycline gel in implant surface decontamination was efficacious in this in‐vitro study. Adjunctive use of locally delivered 14% doxycycline gel might be a viable option in the management of peri‐implantitis and peri‐implant mucositis considering its efficacy in reducing bacterial colonization.     

COVID-19 as a factor associated with early dental implant failures: A retrospective analysis

Objectives

To analyze the effect of COVID-19 on early implant failures and identify potential risk factors for early implant failure, concerning patient- and implant-related factors.

Materials and Methods

This retrospective study is based on 1228 patients who received 4841 implants between March 11, 2020, and April 01, 2022, at Erciyes University Faculty of Dentistry. COVID-19, age and gender of patients, smoking, diabetes, irradiation, chemotherapy, osteoporosis, the implant system, location, and characteristics of implants were recorded. At the implant level, univariate and multivariate generalized estimating equation (GEE) logistic regression was used to examine the effect of explanatory variables on early implant failure.

Results

The early implant failure rate was 3.1% at the implant level and 10.4% at the patient level. Smokers showed a significantly higher incidence of early implant failures compared to nonsmokers. (odds ratio (OR; 95% CI): 2.140 (1.438–3.184); p < 0.001). Short implants (≤8 mm) had a higher risk of early implant failure than long implants (≥12 mm) (OR (95% CI): 2.089 (1.290–3.382); p = 0.003).

Conclusions

COVID-19 had no significant effect on early implant failure. Smoking and short implants were associated with a higher risk for early implant failures.     

Advanced platelet‐rich fibrin and freeze‐dried bone allograft for ridge preservation: A randomized controlled clinical trial

1 Background

Advanced platelet‐rich fibrin (A‐PRF) is an autogenous blood product with applications in dento‐alveolar surgery. However, there is minimal information regarding its optimal clinical application or efficacy. The aim of this multi‐arm parallel randomized controlled clinical trial was to evaluate the efficacy of A‐PRF alone or with freeze‐dried bone allograft (FDBA) in improving vital bone formation and alveolar dimensional stability during ridge preservation.

2 Methods

Forty patients requiring extraction of non‐molar teeth and replacement with dental implants were randomized into one of four ridge preservation approaches: A‐PRF, A‐PRF+FDBA, FDBA, or blood clot. A‐PRF was prepared at 1,300 rpm for 8 minutes. Non‐traumatic extractions and ridge preservation was performed. After an average of 15 weeks healing, bone core samples were harvested at the time of implant placement for micro‐CT and histomorphometric analysis. Ridge dimensions were measured immediately after extraction and before implant placement.

3 Results

Significantly greater loss of ridge height was noted in the blood clot group (3.8 ± 2.0 mm) compared to A‐PRF (1.8 ± 2.1 mm) and A‐PRF+FDBA (1.0 ± 2.3 mm) groups (P < 0.05). No significant differences in ridge width reduction were noted between groups. Significantly more vital bone was present in the A‐PRF group (46% ± 18%) compared to the FDBA group (29% ± 14%) (P < 0.05). Bone mineral density was significantly greater in the FDBA group (551 ± 58 mg/cm³) compared to blood clot (487 ± 64 mg/cm³) (P < 0.05).

4 Conclusions

This study demonstrates A‐PRF alone or augmented with FDBA is a suitable biomaterial for ridge preservation. This study represents the first randomized controlled clinical trial comparing A‐PRF with and without FDBA to FDBA alone for ridge preservation.     

Multivariate study of factors influencing primary dental implant stability

Objectives: The purpose was to determine by multivariate analysis in a large series of dental implants the variables associated with primary endosseous dental implant stability (DIS). Material and methods: A 10‐year retrospective study was conducted of 1084 Brånemark^® implants placed in 316 patients. Clinical variables (age, gender, smoking habit, and periodontal status), implant diameter, implant length, and Periotest^® values (PTVs) were analyzed in bivariate and multivariate studies in order to determine their influence on DIS, using a cut‐off PTV value of ?2. Results: The site of implant insertion showed the strongest association with primary DIS failure among the study variables. Implants in the anterior mandible had a 6.43‐fold lower risk of primary DIS risk vs. those at other sites [95% confidence interval (CI) 3.28–12.61], and implants in the maxillary had a 2.70‐fold higher risk of primary DIS failure vs. those in the mandible (95% CI 1.82–4). Among other variables, females had a 1.54‐fold higher risk of primary DIS failure vs. males (95% CI 1.88–2.22) and implants <15 mm in length had a 1.49‐fold higher risk of failure vs. longer implants (95% CI 1.09–2.04). Conclusion: According to these findings, primary DIS failure is more likely in females, at sites other than the anterior mandible, and with dental implants shorter than 15 mm, at least when non‐threaded titanium implants are used. These data may be of value in the identification of patients at a high risk of primary DIS failure with immediate implant loading.     

Prophylactic antibiotic regimen and dental implant failure: a meta‐analysis

The aim of this meta‐analysis was to investigate whether there are any positive effects of prophylactic antibiotic regimen on implant failure rates and post‐operative infection when performing dental implant treatment in healthy individuals. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomised or not. The search strategy resulted in 14 publications. The I² statistic was used to express the percentage of the total variation across studies due to heterogeneity. The inverse variance method was used with a fixed‐ or random‐effects model, depending on the heterogeneity. The estimates of relative effect were expressed in risk ratio (RR) with 95% confidence interval. Six studies were judged to be at high risk of bias, whereas one study was considered at moderate risk, and six studies were considered at low risk of bias. The test for overall effect showed that the difference between the procedures (use versus non‐use of antibiotics) significantly affected the implant failure rates (P = 0·0002), with a RR of 0·55 (95% CI 0·41–0·75). The number needed to treat (NNT) to prevent one patient having an implant failure was 50 (95% CI 33–100). There were no apparent significant effects of prophylactic antibiotics on the occurrence of post‐operative infections in healthy patients receiving implants (P = 0·520). A sensitivity analysis did not reveal difference when studies judged as having high risk of bias were not considered. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.     

Effect of implant therapy on oral health‐related quality of life (OHIP‐49), health status (SF‐36), and satisfaction of patients with several agenetic teeth: Prospective cohort study

Background

Effect of fixed prosthodontics on patients with several agenetic teeth is not well understood.

Purpose

To assess the effect of implant‐based fixed prosthodontics on oral health‐related quality of life (OHRQoL), general health status, and satisfaction regarding dental appearance, ability to chew and speech in patients with several agenetic teeth.

Materials and Methods

For this prospective cohort study, all patients (≥18 years) with several agenetic teeth who were scheduled for treatment with fixed dental implants between September 2013 and July 2015 at our department were approached. Participants received a set of questionnaires before and 1 year after implant placement to assess OHRQoL (OHIP‐NL49), general health status (SF‐36), and satisfaction regarding dental appearance, ability to chew and speech.

Results

About 25 out of 31 eligible patients (10 male, 15 female; median age: 20 [19;23] years; agenetic teeth: 7 [5;10]) were willing to participate. Pre‐ and post‐treatment OHIP‐NL49 sum‐scores were 38 [28;56] and 17 [7;29], respectively (P < .001). Scores of all OHIP‐NL49 subdomains decreased tool, representing an improved OHRQoL (P < .05) as well as that satisfaction regarding dental appearance, ability to chew and speech increased (P < .001). General health status did not change with implant treatment (P > .05).

Conclusions

Treatment with implant‐based fixed prosthodontics improves OHRQoL and satisfaction with dental appearance, ability to chew and speech, while not affecting general health status.     

Dental implants inserted in male versus female patients: a systematic review and meta‐analysis

The aim of this meta‐analysis was to test the null hypothesis of no difference in the failure rates, marginal bone loss (MBL) and post‐operative infection for implants inserted in male or female patients, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in December 2014. Eligibility criteria included clinical human studies, either randomized or not. Ninety‐one publications were included, with a total of 27 203 implants inserted in men (1185 failures), and 25 154 implants inserted in women (1039 failures). The results suggest that the insertion of dental implants in male patients statistically affected the implant failure rates (RR 1·21, 95% CI 1·07–1·37, P = 0·002). Due to the limited number of studies reporting results on MBL, it is difficult to estimate the real effect of the insertion of implants in different sexes on the marginal bone level. Due to lack of satisfactory information, meta‐analysis for the outcome ‘post‐operative infection’ was not performed. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.     

Impact of different placement depths on the crestal bone level of immediate versus delayed placed platform-switched implants

Purpose

The preservation of peri-implant bone is one requirement for long-term success of dental implants. The purpose of this study was to evaluate the impact of subcrestal placement on the crestal bone level of immediate versus delayed placed implants after loading.

Osteopathology induced by bisphosphonates and dental implants: clinical observations

Objectives

Although there are many reports about risk factors for the development of BP-associated osteonecrosis of the jaws, the role of dental implants as a local risk factor is still discussed, especially in patients with oral BP treatment. Until now, a few case reports and surveys display a possible minor risk in patients with oral BP therapy, whereas the avoidance of implant placement is generally accepted in patients with intravenous BP therapy.

Patient and methods

In this study, the cases of 14 patients with osteonecrosis of the jaws in association with BP therapy and dental implant placement were analyzed carefully with a detailed literature review.

Results

Of 14 patients, nine had underlying malignant disease and five patients had osteoporosis. In ten patients, implants were placed either in the posterior mandible or maxilla; the mean interval between implant insertion and disease onset was 20.9 months. Pain (n12) and signs of infection (n10) were the most common symptoms. Histologically, signs of infection were found in nine of 11 analyzed patients with presence of Actinomyces in six patients. Two patients turned out to have infiltration of underlying malignant disease.

Conclusions

Posteriorly placed implants seem to be of higher risk of development of osteonecrosis of the jaws. Not only the implant placement but also the inserted implant itself seems to be a continuous risk factor.

Clinical relevance

The herein elaborated risk factors help dentists plan dental rehabilitation with implants in this high-risk group of patients and indicate careful and regular dental recall.     

Disparity in embrasure fill and papilla height between tooth‐ and implant‐borne fixed restorations in the anterior maxilla: a cross‐sectional study

Purpose

The objective of the present study was to compare inter‐proximal fill and papilla height between different embrasures.

Material & Methods

One hundred and fifty non‐smoking consecutive patients (mean age 54, range 32–73; 63 males and 87 females) without periodontal disease were selected in a multidisciplinary practice during regular supportive care. All had been treated for multiple tooth loss in the anterior maxilla at least 1 year earlier by means of a fixed restoration on teeth (n = 50) or implants (n = 100) using straightforward procedures (without hard and/or soft tissue augmentation). Embrasure fill was assessed by means of Jemt's papilla index and papilla height was registered following local anaesthesia by means of bone sounding by one clinician.

Results

Tooth‐pontic and tooth‐implant embrasures demonstrated comparable inter‐proximal fill and papilla height (≥58% Jemt's score 3; mean papilla height ≥4.1 mm). Between missing teeth, embrasure fill and papilla height were lower regardless of the embrasure type. The implant‐implant and implant‐pontic embrasure demonstrated comparable outcome (≤42% Jemt's score 3; mean papilla height ≤ 3.3 mm; p ≥ 0.416), which was significantly poorer when compared to the pontic‐pontic embrasure (82% Jemt's score 3; mean papilla height 3.7 mm; p ≤ 0.019). Overall, papilla index and papilla height demonstrated a weak correlation (Spearman's correlation coefficient: 0.198; p = 0.002).

Conclusions

The re‐establishment of a papilla is difficult when there is no tooth involved. In that scenario a short papilla should be expected and implant‐borne restorations demonstrate the poorest outcome. Moreover, an implant with a pontic may not perform better than adjacent implants.     

Does HIV infection have an impact upon dental implant osseointegration? A systematic review

Background

A systematic review is made to determine whether human immunodeficiency virus (HIV) infection has an impact upon dental implant osseointegration.

Material and Methods

A PubMed (MEDLINE) literature search was made of articles published up until 14 April 2014. The systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The quality of the studies included in the review was assessed using the Methodological Index for Nonrandomized Studies (MINORS) and levels of evidence (based on the University of Oxford’s Center for Evidence Based Medicine criteria).

Results

The combinations of search terms resulted in a list of 132 titles. Nine studies finally met the inclusion criteria and were selected for inclusion in the systematic review. A total of 173 dental implants were placed in 80 patients (135 implants in 56 HIV-positive subjects and 38 implants in 24 HIV-negative patients), and a single loss of dental implant osseointegration was recorded in an HIV-positive patient.

Conclusions

Our results suggest that dental implant placement in HIV-positive patients does not increase the dental implant failure rate. Prophylactic antibiotic treatment, the administration of highly active antiretroviral therapy, and control of the CD4+ T lymphocyte counts appear to be the main influencing factors in this respect. Given the few studies included in our systematic review, further prospective studies involving larger sample sizes and longer durations of follow-up are required in order to confirm the results obtained. Key words: Dental implants, implant failure, HIV positive, systematic review, AIDS, HAART.     

Simultaneous sinus membrane elevation and dental implant placement without bone graft: a 6-month follow-up study

Background: Previous studies have shown that simultaneous elevation of the sinus mucosal lining and placement of dental implants without graft materials can be a predictable procedure. Nevertheless, few prospective, controlled, and randomized studies have evaluated this technique. The aim of this prospective, controlled, and randomized clinical study is to evaluate whether sinus membrane elevation and simultaneous placement of dental implants without autogenous bone graft can create sufficient bone support to allow implant success 6 months post‐surgically. Methods: Sinus membrane elevation and simultaneous placement of dental implants were performed bilaterally in 15 patients in a split‐mouth design. The sinuses were assigned to two groups: the test group, with simultaneous sinus mucosal lining elevation and placement of dental implants without graft materials; and the control group, with simultaneous sinus mucosal lining elevation and placement of dental implants with intraoral autogenous bone graft. After 6 months of healing, abutments were connected. For each implant, length of implant protrusion into the sinus, resonance frequency analysis, and bone gain were recorded at baseline and 6 months follow‐up. Results: Clinical complications were not observed, except for two postoperative fistulas and suppuration in both groups. Only one implant of the test group was lost, reaching a success rate of 96.4% and 100% for the test and control groups, respectively. After healing, radiographic new peri‐implant bone was observed in both groups ranging between 8.3 ± 2.6 and 7.9 ± 3.6 mm for the control and test groups, respectively (P >0.05). Resonance frequency analysis values were lower for the control group compared to baseline (P <0.05). However, these values were similar at 6 months (P >0.05). A significant positive correlation was found between the protruded implant length/bone gain and implant survival/sinusitis (P <0.0001). Conclusion: Implants placed simultaneously to sinus membrane elevation without graft material resulted in bone formation over a period of 6 months.