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Featured Application: This study aims to validate a new diagnostic test that predicts the risk of peri-implantitis, thereby enabling early intervention and improved implant survival rates. The aim of this parallel group study was to determine the clinical applicability of a newly developed bacterial test. We evaluated the ability of the test to detect five bacteria associated with peri-implantitis: Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Treponema denticola. Sensitivity, specificity, and positive and negative predictive values were established. Furthermore, by analyzing the pre-test and post-test probabilities, likelihood ratios were established, and a Fagan nomogram was constructed. As the standard, the clinical criteria of peri-implantitis adopted in the latest classification of peri-implant diseases of 2018 were used. The sample consisted of 13 patients clinically diagnosed with peri-implantitis (various implant brands) with at least 1 year of loading, of whom 11 were included in the study. The healthy group comprised 10 patients who received implants (Ticare inhex hybrid) at the university dental clinic and were monitored and exhibited no signs or symptoms of peri-implantitis during 1 year of loading. The results indicated that this test has high sensitivity and low specificity; therefore, positive results will be of great importance for a confirmatory diagnosis of peri-implantitis. However, the test is not suitable as a screening tool. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact of different extents of misfit between a restoration and the supporting implant on veneer fractures in screw-retained implant-supported metal-ceramic fixed dental prostheses (FDPs).Materials and Methods: A finite element analysis (FEA) model of a five-unit screw-retained metal-ceramic FDP supported by three implants was constructed, replicating a previous in vitro study. Eight different gap configurations at the single terminal implant, ranging from 0 to 150 μm, were tested. All setups were tested after clamping and with a load of 200 N applied. Maximum stress within the FDP was calculated.Results: The stress increased with each increase in misfit size above 30 μm, with the relationship between gap size and stress being linear up to 100-μm misfit. Above 100 μm, the stress increase accelerated. The stress pattern within the FDP changed with increasing gap size, confirming the findings of a previously conducted in vitro experiment for a misfit of 150 μm.Conclusion: The results of the FEA were in agreement with in vitro observations, validating the predictive value of FEA for technical complications. A misfit between an FDP and a supporting implant implies an increased risk of veneer fracture. Above a misfit of 30 μm, the stress levels are likely to be high enough to cause veneer fracture, and the risk increases disproportionately for misfit above 100 μm. [ABSTRACT FROM AUTHOR]

Purpose: To assess the clinical outcomes of maxillary overdentures supported by dental implants by conducting a literature review.Materials and Methods: An electronic search was undertaken in March 2019. Eligibility criteria included publications reporting cases of implant-supported maxillary overdentures with follow-up information.Results: A total of 131 publications were included (1,478 overdentures supported by 6,681 implants). The mean number of attachments per overdenture was 3.8 ± 1.2 (range: 1 to 9), and a bar-clip system was used in about half of the cases. The prostheses were followed up for a mean of 47.9 ± 32.8 (range 1: to 240) months. A total of 401 implants (6.0%) failed in 219 patients (14.8%), and 55 prostheses (3.7%) failed at a mean of 40.2 ± 53.2 (6 to 240) months after placement. Most of the failures happened within the first year after placement for both implants (52.1%) and prostheses (41.8%). Patients with fewer implants per prosthesis presented higher prosthesis failure rates than patients with more implants per prosthesis. The cumulative survival rate for dental implants after 19 years was 70.4%, and for implant-supported maxillary overdentures was 79.8%. Presence of palatal coverage and/or metallic structure/reinforcement does not seem to have an influence on failure rate. Of the most commonly used attachment systems, the ball/O-ring and the Ceka were the ones with the highest rates of patients having at least one implant failure.Conclusion: Most of the prosthesis failures were due to loss of implants, and the first year was the most critical period for failures. The number of dental implants placed per patient seemed to have an impact on the occurrence of overdenture failure. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate initial implant stability and initial healing around newly placed dental implants in well-controlled type 2 diabetes patients. Materials and Methods: Forty patients requiring implant therapy comprising 15 nondiabetic and 25 diabetic patients were recruited for this prospective study. Implant stability quotient and bone biomarkers such as osteopontin, receptor activator of nuclear factor-kB ligand, and interleukin 8 were evaluated at baseline and 1 and 3 months using Osstell Mentor and enzyme-linked immunosorbent assay, respectively. Results: Mean implant stability quotient values showed a statistically significant difference at each interval in both of the groups except between 1 and 3 months in the diabetic group. The percentage increase in implant stability quotient values was more in the nondiabetic (14.2%) than in the diabetic group (6.03%) from 1 to 3 months. Significant variations were observed in all three bone biomarkers between baseline and 3 months at P < .002 in both groups. In the diabetic group, receptor activator of nuclear factor-kB ligand showed a higher reduction from baseline to 3 months, whereas interleukin 8 showed a less significant decrease between baseline and 1 month. Changes in correlation between implant stability and bone biomarkers were noted in the initial period of healing between the two groups. Conclusion: Variations in the pattern of response of osteopontin, receptor activator of nuclear factor-kB ligand, interleukin 8, and initial implant stability are noted in well-controlled diabetic individuals. [ABSTRACT FROM AUTHOR]

Purpose: Immediate replacement of a new implant for a failed implant has the benefit of reducing treatment time and increasing patient satisfaction. Limited studies have reported the outcome of implants placed in previously failed sites. It has been proposed that porous tantalum trabecular implants (TM implants) may offer superior integration due to their structure and may be beneficial in situations that normally present a clinical challenge. The purpose of this pilot study was to analyze dental implant survival in a series where failed implants were immediately replaced by TM implants. Materials and Methods: This pilot study assessed 16 implants in 14 patients where failed implants were immediately replaced by TM implants. All clinical procedures were performed by the same board-certified periodontist in a private practice setting. The implants were restored 8 to 10 weeks postoperatively with stock contour abutments and cemented crowns. Patients were recalled yearly for radiographs and clinical assessment of probing depth, bleeding on probing, and integration status. Data were collected on patient demographics, smoking status, periodontal health status, implant site and size, and the use of membranes and/or grafts. Descriptive statistics were used to describe the demographics of the study population and to calculate overall implant survival proportions. Results: The mean age at time of first implant placement was 54.4 years, with a range of 41 to 74 years. Distribution by sex was evenly split at 50% men and 50% women. The majority of patients were smokers (68.8%), and 75% of the patients had a history of moderate or severe periodontal disease. For the replacement TM implants, most were a larger size than the original implant, 6 x 10 vs 4.8 x 10. Sixteen implants were immediately placed into failed implant sites, and 15 had a successful outcome and continue to maintain function at 5 years post-implantation. Radiographs of the TM implant site showed excellent boneto- implant contact, and the patients did not show clinical signs or symptoms of pain, mobility, infection, or tenderness. Conclusion: Although the limited sample size limits comparisons to larger studies, this initial finding suggests that TM implants may be suitable for immediate placement into failed implant sites. [ABSTRACT FROM AUTHOR]

Recently published surveys data show that the routine prescription of preventive antibiotics (PA) in the prosthetic phase of dental implants is more common than might be expected. The present study aimed to answer the PICO (population, intervention, comparison, and outcome) question "In healthy patients starting the implant prosthetic phase, does the prescription of PA compared with not prescribing PA decrease the incidence of infectious complications?" by a systematic literature review. A search was performed in 5 databases. The criteria employed were those described in the PRISMA Declaration. Studies included were those that provided information on the need to prescribe PA in the prosthetic phase of implants, that is, in second-stage surgeries, impression-taking, and prosthesis placement. The electronic search identified 3 studies that met the established criteria. The prescription of PA in the prosthetic phase of implants does not show a justified benefit/risk ratio. Preventive antibiotic therapy (PAT) may be indicated in the second stages or in peri-implant plastic surgery procedures lasting more than 2 hours and/or where soft tissue grafts are used extensively. In these cases, given the current lack of evidence, it is recommended to prescribe 2 g of amoxicillin 1 hour before surgery and, in allergic patients, to prescribe 500 mg of azithromycin 1 hour preoperatively. [ABSTRACT FROM AUTHOR]

The article discusses issues in dentistry, particularly the potential complications of dental implants like the inflammation called peri-implantitis, and the possible remedies. Other topics include the signs and symptoms of peri-implantitis, peri-implant mucositis as precursor of peri-implantitis, and the need for regular homecare to maintain soft tissue.

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. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the vertical marginal (VM) and horizontal marginal (HM) misfit of frameworks made using different techniques.Materials and Methods: A total of 30 frameworks were divided into three groups of 10 samples each based on manufacturing technique: nichrome cast (G1), milled in zirconia (G2), and milled in wax and fused to metal (G3). Marginal misfit was measured using a three-dimensional optical microscope.Results: The highest VM misfit was in G3 (83.5 μm), followed by G1 (55 μm) and G2 (42 μm). The highest HM misfit was in G2 (118 μm), followed by G3 (102 μm) and G1 (-85 μm).Conclusion: Frameworks milled in zirconia resulted in the lowest VM misfit, while frameworks filled in wax and fused to metal resulted in higher VM. The HM misfit was favorable in the lost-wax technique. [ABSTRACT FROM AUTHOR]

An effective treatment regime for peri-implantitis (P-I) should include disinfection and regeneration of peri-implant tissues. Twenty consecutive patients exhibiting 23 P-I implants with 84 deep (≥ 6 mm) defects were treated using an Er:YAG laser for implant surface decontamination, removal of defect granulomatous tissues, and grafting therapy for bony defect resolution. Probing pocket defects (PPD) ≥ 6 mm (deep probing depths) before surgery were reduced on average to approximately 3.5 mm at 12 months. Probing depths < 6 mm (shallow probing depths) remained stable (mean PPD 3.2 mm at 12 months). Radiographs indicated PPD reductions were achieved along with peri-implant defect fill. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the current scientific evidence on estimating cumulative risk for biologic complications relating to dental implants and to develop a patient-centered risk assessment tool for establishing aggregate risk. Materials and Methods: A review of the scientific literature on risk indicators relating to dental implants was completed with the goal of identifying and weighting individual risk indicators so aggregate biologic risk could be estimated. Three authors completed independent reviews of the literature, identifying 31 systematic reviews on risk indicators for biologic complications with dental implants, from which 24 potential risk indicators were considered. Due to inconclusive scientific data on risk indicators, a Delphi process was used to gather structured expert opinion to supplement findings from the literature. Eleven Delphi participants with expertise in prosthodontics or periodontics participated in two email exchanges and one face-to-face meeting to comment and debate on the initial identification and weighting of risk indicators, propose the addition or removal of risk indicators, and provide recommended clinical management for each risk indicator. Results: After literature review, three rounds of debate, and additions and removals of various risk indicators, consensus (defined as 95% or more in agreement) was achieved on 20 risk indicators. The Delphi group concluded that the risk indicators of smoking, diabetes, periodontal disease, plaque levels, antiresorptive agents, and cemented restorations should include subcategories to more accurately identify and represent patient-specific risk. Clinical recommendations based on individual and aggregate risk were established by consensus. Conclusion: The literature on risk indicators for biologic complications was conflicting and inconclusive. The Delphi method was used to identify and establish the weighting of individual risk indicators, resulting in a risk assessment tool for estimating aggregate risk. [ABSTRACT FROM AUTHOR]

Purpose: To report implant failures in partially edentulous patients over a long-term period, focusing on differences in treatment outcomes between maxillary vs mandibular arches and different implant surfaces.Materials and Methods: Altogether, 2,453 patients were consecutively treated with 9,167 implants in 2,915 partially edentulous arches (Kennedy Class I or II) between 1986 and 2015 at one referral clinic. Implant failures were recorded on a routine basis at the clinic during follow-up, and the failures were analyzed with a focus on associations with treated arch and implant surface by means of a multivariable regression analysis.Results: Cumulative survival rates (CSRs) for arches provided with turned surface implants were 92.2%, 90.6%, 89.7%, and 88.3% after 5, 10, 15, and 25 years, respectively. Corresponding CSRs for arches provided with moderately rough surface implants were 95.7% and 95.2% after 5 and 10 years, respectively. Two individual surgeons and prosthetic treatment outside the referral clinic showed strong associations with early implant failure (P < .05). Implants with a turned surface showed an increased risk for failure early after surgery (< 1 year), but a comparable pattern of a reduced risk by time was present during the late period of follow-up (> 1 year) for both surface types. Variables associated with the number of implants per operation were associated with increased risk of implant failure for both implant surface types (P < .05).Conclusion: Individual surgeons seem to have an important impact on early risk of implant failure in combination with implant surface, number of placed implants, wide-platform implants, and treatment in the mandible. Observed differences in survival between different implant surfaces seem to be established early after surgery, but the risk during the following long-term period is reduced by time, and risk seems to be comparable for both surface types in both the maxilla and the mandible during maintenance. [ABSTRACT FROM AUTHOR]

Peri-implant mucositis has been defined as a reversible inflammatory reaction in the soft tissues around a functioning implant with no bone loss. This paper reviews the prevalence, etiology, risk indicators, prevention, and treatment of mucositis. Relying on the literature concerning mucositis, the bacterial etiology is discussed as well as the varying ranges of prevalence, reported to be from 20% to 80% of subjects (13% to 62% of implants) after a minimum of 5 years of implant function. A discussion of the definition of mucositis questions the assumption of it being completely reversible following treatment and challenges the concept of mucositis "transfer" (conversion) to peri-implantitis. [ABSTRACT FROM AUTHOR]

Systematic reviews showed possible esthetic complications with the use of traditional flap designs after guided bone regeneration (GBR) procedures in the esthetic zone and the aim of this case series was to analyze hard and soft tissue changes over 18 months after these procedures. Healthy subjects requiring tooth extraction and single-implant placement in the anterior maxilla were enrolled in the study. Three months after tooth extraction and ridge preservation, a prosthetic-driven implant was placed. The horizontal bone deficiency was treated with a resorbable bone graft substitute (beta tricalcium phosphate [β-TCP]) and a bioresorbable polylactic acid (PLA) membrane. Primary closure was obtained by a novel coronally advanced flap adapted from mucogingival techniques. Final metal-free implant restorations were delivered 4 months after placement. Clinical measurements, pictures, and radiographs were acquired after delivery of the final restoration (T1) and at the 18-month follow-up (T2). Digital impressions were taken at the time of tooth extraction (T-1) and implant insertion (baseline; T0) and at T2. Marginal bone level changes were assessed by radiographic analysis, while soft tissue changes were evaluated with ExoCad software. Student t test for paired data was used to detect differences between the different time points. Twelve subjects (7 men and 5 women; mean age: 63.7 ± 14 years) completed the study and received 15 implants. All implants healed uneventfully and were clinically osseointegrated and stable, showing no sign of infection. No GBR complications were noted. Statistically significant ridge-width changes were observed after extraction (T-1 vs T0 = -1.72 ± 0.30 mm; P = .00001) and after horizontal GBR (T0 vs T2 = 1.41 ± 0.64 mm; P = .00001). Radiographic bone levels after implant placement remained stable T0 to T2 (0.09 ± 0.08 mm). Periodontal parameters never exceeded physiologic levels. It can be concluded that GBR using a bioresorbable PLA membrane and resorbable β-TCP bone graft in conjunction with a coronally advanced flap is a predictable procedure for horizontal bone augmentation with simultaneous implant placement in the esthetic area. [ABSTRACT FROM AUTHOR]

An undesirable injury of adjacent teeth is one of many accidents that may occur during implant placement. Limited surgical access in a noncooperative patient can induce apical root transection. When endodontic pathosis is identified, root canal treatment is often initiated to prevent implant microbial contamination. This case report demonstrates the successful resolution of implant endodontitis by endodontic intervention without any surgical treatment in a patient presenting a moderate mental disorder. [ABSTRACT FROM AUTHOR]

This study investigated the level of magnetic energy around implants possessing a static magnetic field (SMF) and assessed the in vivo influence of SMF on bone regeneration. Implants possessing a sintered neodymium magnet internally were placed in a rabbit femur. An implant without SMF was placed as control. After 12 weeks of healing in vivo, the bone samples were subjected to histologic/histomorphometric evaluation. The bone-toimplant contact for the test group and the control group were 32.4 ± 13.6% and 17.1 ± 4.5%, respectively, and the differences were statistically significant (P < .05). The results suggested that the SMF promoted new bone apposition. [ABSTRACT FROM AUTHOR]

Purpose: To report implant failure rates in a large group of partially edentulous patients over a long-term period and to analyze possible associations between available clinical variables and implant failure.Materials and Methods: Altogether, 2,453 patients were consecutively provided with 9,167 implants in 2,915 partially edentulous arches (Kennedy Class I or Class II) between 1986 and 2015 at one referral clinic. All implant failures recorded at the clinic during follow-up were identified and analyzed in relation to available clinical variables by means of a multivariable regression analysis.Results: Overall cumulative survival rates (CSRs) for treated arches without any implant failures after 15 and 25 years were 91.7% and 90.3%, respectively, and the corresponding CSRs for implants were 96.1% and 95.3%, respectively. Out of the 209 arches with reported implant failures, 112 were reported with failures during the first year (54%). The strongest associations with risk for overall implant failure were related to two different surgeons (hazard ratio 6.14 [2.77 to 13.60] and 1.51 [1.14-1.99]). Number of implants, time since surgery, calendar year of surgery, and age at surgery were also significantly associated with overall implant failure. Furthermore, early implant failures were associated with implant surface (HR 2.27 [1.43 to 3.57]), indicating higher risk for implants with a turned surface. This variable was not observed for overall or late implant failures.Conclusion: Individual surgeons seem to have an important impact on risk for implant failure in combination with implant surface and number of placed implants during the early period after surgery. Besides the surgeon and number of implants, the overall trend seems to be a decreasing risk for failure the longer the patient is followed up, the later the patient is included, and the older the patient is at treatment. [ABSTRACT FROM AUTHOR]

This article describes two case reports of immediate full-arch dental implant" supported prostheses using facial parameters to determine the anticipated incisal edge (AIE) position. Treatment planning the terminal dentition is driven by several facial parameters. A frontal photo is obtained to assess the facial thirds and the symmetry in the lower third. A profile photo allows the clinician to measure Holdaway's angle, nasolabial angle, and labiomental sulcus depth and anatomy. Facial assessment is a diagnostic tool that assists the clinician in addressing the challenges of ideal tooth position in the absence of dental landmarks to achieve dentofacial esthetics. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the optimal positioning of implants for maxillary implant-supported overdentures (MIODs) using finite element analysis (FEA).Materials and Methods: Three-dimensional (3D) finite element models were built incorporating the maxilla, mucous membrane, removable denture, and artificial teeth using FEA software. Four models were prepared: one without an implant; one with two implants in the region of the lateral incisor; one with two implants in the first premolar region; and one with four implants in the lateral incisor and first premolar regions. Occlusal load was applied to the model, and denture displacement and the distribution of stress in the surrounding bone and mucous membrane were observed and measured.Results: The maximum equivalent stresses to the bone and mucous membrane were highest in the premolar and anterior areas, respectively. Stress to the bone was concentrated around the implants, whereas stress in the mucous membrane was concentrated along the posterior margin. Denture displacement in the anterior direction was highest in the model without implants, while denture displacement in the posterior direction was less affected by the presence of implants. Overall, denture displacement in the four-implant model was smaller than that in the other models. Implant angle affected the stress distribution, with highest stress to the bone when the implant was positioned in a palatal direction and highest stress to the mucous membrane when placed mesially. However, implant angle had little impact on denture displacement, with almost the same stress for implants at all tested angles.Conclusion: Optimal implant position can stabilize overdentures and reduce stress to the bone and mucous membrane. Stress is reduced when implants are inserted in the premolar area and when the direction of the implant is perpendicular to the occlusal plane. [ABSTRACT FROM AUTHOR]

Purpose: To report retro-prospective, long-term data on the prevalence of implant failures related to maxillary and mandibular arches and to different implant surfaces in a large number of edentulous patients.Materials and Methods: Altogether, 3,493 and 1,092 edentulous arches were consecutively treated with implants with turned (1986-2002) or moderately rough (2003-2015) surfaces, respectively, during two time periods at one referral clinic. All implant failures were consecutively identified during routine follow-up, and a multivariate logistic regression analysis was performed to analyze implant failure related to arch and implant surface.Results: Overall cumulative survival rates (CSR) for arches treated with turned surface implants were 75.7% and 94.6% for the maxilla and mandible, respectively. The corresponding 10-year CSRs for arches treated with implants with a moderately rough surface were 91.9% and 96.1%, respectively. The strongest significant association (P < .05) with risk for implant failure was the maxilla, and this was more pronounced for implants with a turned surface. Age at surgery, implant surgeon, calendar year of surgery, and time of follow-up also had significant associations with risk of implant failure (P < .05).Conclusion: Risk for implant failure was significantly higher for treatment in the maxilla, but this risk was decreased significantly when using implants with a moderately rough surface. The impact of surface was not so obvious for treatment in the mandible. Risk for late implant failures after the first year was lower for implants with a moderately rough surface in the maxilla, but this risk seemed to be comparable for the different surfaces in the mandible. [ABSTRACT FROM AUTHOR]

The aim of this study was to document the performance of a novel technique (OnlyOne), involving immediate restoration of postextraction implants supporting a partial or full-arch restoration. A retrospective analysis of patients with at least 3 years of follow-up was performed. Implants were tilted mesiodistally and vestibulopalatally according to the available bone. Prosthetically guided definitive abutments were connected at surgery and never disconnected. Anorganic bovine bone grafting was done to preserve the buccal bone and the ridge contour. Patients received a screw-retained provisional prosthesis within 24 hours of surgery and a final screw-retained prosthesis within 1 year. Prostheses emerged from natural soft tissue. Clinical and radiographic evaluation was routinely performed. A total of 70 patients received 153 implants in fresh extraction sockets. The mean follow-up was 38.0 ± 3.0 months (range 36 to 51 months). One implant failed at the 3-year follow-up. Implant survival was 99.3%. Marginal bone level change averaged -0.68 ± 1.2 mm at the last radiographic control. Immediate placement and restoration of implants designed for high primary stability with a definitive abutment placed at surgery and final screw-retained prosthesis with no artificial gingiva is a viable procedure with excellent medium-term outcomes. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine wound healing in extraction sockets following ridge preservation and the outcome of implants placed in those sites. Extraction sockets (N = 31) were grafted with anorganic bovine bone mineral (ABBM) and covered with dense polytetrafluoroethylene membrane. Bone cores obtained during implant placement were examined histologically and histomorphometrically. Percentages of vital bone and residual graft were 37.5% ± 21.3% and 12.5% ± 8.9%, respectively. New vital bone showed a negative correlation with patient age. Percentage of vital bone formation in sockets was correlated with neither postgraft wound healing time nor peri-implant marginal bone level. [ABSTRACT FROM AUTHOR]

The aim of this parallel group study was to determine the clinical applicability of a newly developed bacterial test. We evaluated the ability of the test to detect five bacteria associated with peri-implantitis: Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Treponema denticola. Sensitivity, specificity, and positive and negative predictive values were established. Furthermore, by analyzing the pre-test and post-test probabilities, likelihood ratios were established, and a Fagan nomogram was constructed. As the standard, the clinical criteria of peri-implantitis adopted in the latest classification of peri-implant diseases of 2018 were used. The sample consisted of 13 patients clinically diagnosed with peri-implantitis (various implant brands) with at least 1 year of loading, of whom 11 were included in the study. The healthy group comprised 10 patients who received implants (Ticare inhex hybrid) at the university dental clinic and were monitored and exhibited no signs or symptoms of peri-implantitis during 1 year of loading. The results indicated that this test has high sensitivity and low specificity; therefore, positive results will be of great importance for a confirmatory diagnosis of peri-implantitis. However, the test is not suitable as a screening tool.

Aim: In this systematic review, we aimed to assess the impact of endosseous implants on the formation of an osteonecrosis of the jaw, as well as implant survival rates for patients under bisphosphonate (BP), antiresorptive and radiation therapy. Materials and methods: An electronic search was performed using PubMed, Embase, and Medline databases with the logical operators: "dental implant", "antiresorptive", "bisphosphonate", "irradiation", "radiotherapy", "radiation", "necrosis" and "survival". The search was limited to articles published up to 15 December 2016. Recent publications were also searched manually to find any relevant studies that might have been missed using the search criteria noted above. The outcome variables were the implant survival rate and the frequency of osteonecrosis of the jaws. Results: In total, 18 studies addressing oral implants in patients with BP or antiresorptive therapy and 23 with radiation therapy met the inclusion criteria and were included in this systematic review. Most of the studies had a retrospective design with a level of evidence (LoE) of III (moderately high risk of bias). Implant survival rate ranged from 92.86% to 100% in patients with BP/antiresorptive therapy (all due to osteoporosis) and 38.5% to 97.9% in patients with radiation therapy. For BP patients, osteonecrosis in relation to oral implants more frequently occurred in patients taking BPs due to malignant diseases. In patients with radiation therapy, an "implant triggered" necrosis is also a potential complication. The lack of data in the current literature concerning this issue does not allow a proper risk assessment to date. Conclusions: Within the limits of this systematic review, implant treatment concepts seem to be a valuable approach in patients with radiation therapy and patients with BP therapy due to an osteoporosis. In patients taking BPs due to a malignant disease, implant treatments are not recommended due to the high number of reported implant-related necrosis in this patient cohort. Outcomes of this review should, however, be regarded with caution due to the low level of evidence of the currently existing data. [ABSTRACT FROM AUTHOR]

Aim: The objective of this systematic review was to evaluate the diagnostic value of CBCT compared with 2D imaging and clinical gold standard techniques in peri-implant bone defect detection and measurement. Materials and methods: Literature search was performed using MEDLINE, Embase and Web of Science databases up to July 2017. Clinical, ex vivo, in vitro and animal studies that assessed and measured peri-implant bone defects using different imaging modalities were included in this review. Two reviewers performed data extraction and qualitative analysis. The methodological quality of each study was reviewed using the QUADAS-2 tool. Results: The initial search revealed 2849 unique papers. Full-text analysis was performed on 60 articles. For the present review, nine studies were considered eligible to be included for qualitative analysis. CBCT performed similar to intraoral radiography in mesiodistal defect detection and measurements. Additional buccolingual visualisation and volumetric and morphological assessment of peri-implant bone defects are major advantages of 3D visualisation with CBCT. Nevertheless, one must be aware of metal artefacts masking osseointegration, shallow bony defects and other peri-implant radiolucencies, thus impeding early diagnosis of intrabony lesions. Conclusions: The present review did not provide evidence to support the use of CBCT as standard postoperative procedure to evaluate peri-implant bone. Up to date, we are clinically forced to remain with intraoral radiography, notwithstanding the inherent limitations related to restricted field of view and two-dimensional overlap. A 3D imaging approach for postoperative implant evaluation is crucial, making further development of an optimised and artefact-free CBCT protocol indispensable. [ABSTRACT FROM AUTHOR]

Aim: A large variety of dental materials are available for the production of implant-supported fixed restorations. Materials with different properties are likely to behave differently during clinical function, which may result in different prevalence and types of complications. The aim of the present review was to summarise, analyse and discuss the prevalence and types of complications or failures related to dental materials in implant-supported restorations. Materials and methods: A strategy was set up using the PICO format and the search was performed using the PubMed database, including a hand search of reference lists. Two independent reviewers selected papers based on a set of criteria. The number of events of complications was summarised. Results: The initial search produced 2764 titles. After application of criteria, 47 publications were selected for analysis. Seventeen studies reported on 1447 single crowns and 30 studies reported on 2190 fixed dental prostheses. The most common complications were fracture or chipping of the veneer material, loss of retention and lost access hole fillings. Due to the heterogeneity of studies, and large variation in number of restorations per material group, no conclusive correlation between type of material and type of technical complication and/or failure could be established. Conclusions: The review did not succeed in providing convincing evidence to answer the question concerning a possible relationship between restoration materials and prevalence of technical complications in implant-supported restorations. [ABSTRACT FROM AUTHOR]

This review provides an overview of review and consensus articles of the past 5 years regarding surgical complications in implant dentistry. The focus in this article is on surgical complications occurring after implant insertion and on risk factors that compromise oral implant osseointegration. [ABSTRACT FROM AUTHOR]

Aim: In this review, we look at the factor of the surgical experience and surgical workload in a variety of surgical disciplines and its effect on the intraoperative and postoperative complications rate. Materials and methods: An extensive systematic electronic search was carried out on the relevant databases. Two independent reviewers were engaged in selecting appropriate articles in line with the protocol. Results: It was very interesting to see that only 52 studies could be identified as per the inclusion criteria and search keywords. This included studies from 1990 onwards, spanning all surgical disciplines. Six studies were identified in third molar surgery, one of the most common surgeries practiced across all surgical disciplines. Seven appropriate oral implant surgery studies were identified, covering two-stage implants and immediately loaded implants. The evidence was overwhelming that the surgeon's experience positively correlates with the level of osseointegration and implant success. An interesting study from general surgery highlighted the fact it is not unusual to see senior surgeons selected to operate on complex patients or carry out complex surgical procedures than their junior colleagues. In face, this may explain why a number of studies identified no difference in the surgical complications between seniors and juniors. Conclusions: Despite the fact that experience matters, many factors can influence the outcome of the surgery. If the surgeon, despite his/her lack of seniority, manages to utilise experience appropriately then there will be a beneficial outcome for the patient. [ABSTRACT FROM AUTHOR]

Aim: To present recent data regarding prosthetic complications with implant prostheses and crowns as well as compare this data with data presented in a 2003 publication. Material and methods: An electronic Medline (PubMed) with MeSH terms search was performed, focussing on clinical studies that reported data on prosthetic complications associated with implant fixed complete dentures, implant overdentures, implant fixed partial dentures, and implant single crowns. Results: There were nine prosthetic complications reported with implant fixed complete dentures, 17 with implant overdentures, four with implant fixed partial dentures, and six with implant single crowns. The greatest number of complications and the largest incidence of percentages occurred with implant overdentures. The lowest incidence percentages were recorded for implant single crowns. These findings are in agreement with the previous 2003 publication. It is of interest to note that some of the complications reported previously were not reported in this review, and some complications reported in this review were not listed in the 2003 publication, thereby limiting the number of direct comparisons between this paper and the earlier report. A surprising finding was that some complications associated with implant overdentures from the current data exceeded the incidence in 2003 (reactivation of the retentive attachment; mucosal hyperplasia; and the need for overdenture relines). Conclusions: Implant overdentures are associated with more complications than implant fixed complete dentures, implant fixed partial dentures, and implant single crowns. The lowest incidence of complications was reported with implant single crowns. The most common complication reported with implant fixed complete dentures was denture tooth fracture. The most common complication associated with implant overdentures was the need for adjustments. Porcelain veneer fracture/chipping was the most common complication identified in the studies of implant fixed partial dentures. The most common complication reported with implant single crowns was abutment screw loosening. [ABSTRACT FROM AUTHOR]

Aim: To describe general observations of immunological reactions to foreign materials and to realize that CP titanium gives rise to a foreign body reaction with subsequent bone embedment when placed as oral implants. To analyse the possibility of titanium allergy. Materials and methods: The present paper is of a narrative review type. Hand and Medline searches were performed to evaluate marginal bone loss of oral implants and the potential of titanium allergy. Results: Immunological reactions to foreign substances include Type I hypersensitivity reactions such as allergy, Type II hypersensitivity reactions characterised by IgM or IgG antibodies that may react with blood group antigens at transfusion, and Type III hypersensitivity caused by antigen-antibody immune complexes exemplified by acute serum sickness. There is also Type IV hypersensitivity, or delayed hypersensitivity, which is typically found in drug and foreign body reactions. It proved very difficult to find a universally acceptable definition of reasons for marginal bone loss around oral implants, which lead to most varying figures of so-called peri-implantitis being 1% to 2% in some 10-year follow-up papers to between 28% and 56% of all placed implants in other papers. It was recognised that bone resorption to oral as well as orthopaedic implants may be due to immunological reactions. Today, osseointegration is seen as an immune-modulated inflammatory process where the immune system is locally either up- or downregulated. Titanium implant allergy is a rare condition, if it exists. The authors found only two papers presenting strong evidence of allergy to CP titanium, but with the lack of universally accepted and tested patch tests, the precise diagnosis is difficult. Conclusions: CP titanium acts as a foreign body when placed in live tissues. There may be immunological reasons behind marginal bone loss. Titanium allergy may exist in rare cases, but there is a lack of properly designed and analysed patch tests at present. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze the degree of mineralization around nine clinically stable titanium dental implants retrieved after 2 months to 17 years for mechanical complications from five patients. The micromorphology and microchemistry of the interface bone at the coronal and apical sides of the threads were analyzed by environmental scanning electron microscope and energydispersive X-ray spectroscopy (EDX) on histologic samples. Mineralization was investigated by atomic calcium-to-nitrogen (Ca/N), phosphorous-to-nitrogen (P/N), and calcium-to-phosphorous (Ca/P) ratio evaluation (statistical analysis by two-way analysis of variance with Student-Newman-Keuls; P < .05). EDX showed higher Ca/N, P/N, and Ca/P values for the bone at the coronal side compared to the apical side of the threads in the long-term (≥ 14 years) samples. The two most significant findings were that (1) the interface bone located at the coronal side of the implant threads was generally more mineralized than the interface bone located at the apical side, and (2) the mineralization of the peri-implant bone at the interface increased over time. A higher degree of mineralization was found at 2 months in an immediately loaded implant when compared to the 2-month submerged unloaded control, likely related to the different remodeling events (coronal vs apical side of the implant threads) due to the direction of the loading forces. [ABSTRACT FROM AUTHOR]

Objective: Fracture of osseointegrated dental implants is the most severe mechanical complication. The aim of the present study was to analyze possible causative factors for implant body fracture. Method and Materials: One hundred and one patients with 218 fitted implants and a follow-up period of 3 to 10 years were studied. Factors associated with biomechanical and physiologic overloading such as parafunctional activity (eg, bruxism), occlusion, and cantilevers, and factors related to the planning of the dental prosthesis, available bone volume, implant area, implant diameter, number of implants, and their inclination were tracked. The impact of their effect was analyzed using the Bonferroni-corrected posthoc Mann-Whitney test for each group. Results: The incidence of dental implant fracture was 2.3% in the investigated cases. Improper treatment planning, bruxism, and time of the complication setting in were the main factors leading to this complication. Typical size effect was established only for available bruxism, occlusal errors, and their activity duration. These complications were observed most often with single crown prostheses, and in combination with parafunctional activities such as bruxism and lack of implant-protected occlusion. Conclusion: Occlusal overload due to bruxism or inappropriate or inadequate occlusion as a single factor or a combination of these factors during the first years after the functional load can cause implant fracture. Fracture of the implant body more frequently occurred with single crowns than with other implant-supported fixed dental prostheses. [ABSTRACT FROM AUTHOR]

Purpose: The use of antibiotic prophylaxis in dental implant surgery is a routine dental practice to prevent implant failure. Current systematic reviews have yet to confirm the effectiveness of antibiotic treatment at reducing postoperative infection rates in implant procedures. The aim of this study was to quantify amoxicillin plasma levels at the peripheral venous blood and at the surgical implant site in patients undergoing dental treatment. Materials and Methods: A prospective study was conducted. Patients undergoing dental implant surgery were selected, and preoperative doses of 1 g of amoxicillin, in the form of an oral tablet, were administered 1 hour prior to implant surgery. The blood samples (1.5 mL) were collected from both the venous and implant sites. Data on the antibiotics were measured using high-pressure liquid chromatography. The quantification method was validated for linearity, selectivity and detection limits. Statistical analysis of plasma antibiotic was performed, comparing both samples and the age, height, weight, and body mass index (BMI) (Wilcoxon test, P < .05; STATA v.10.0). Results: Thirty-two patients (mean age: 56.28 ± 12.2 years; range: 31 to 79 years; 20 men) were selected. Both blood samples were taken at a mean 1.16 ± 0.37 hours after antibiotic intake. The mean amoxicillin concentration at the implant site reached 5 ± 2.63 μg/mL (range: 2.04 to 11.18 μg/mL), while the venous blood level was 4.21 ± 2.12 μg/mL (range: 1.6 to 9.98 μg/mL) (P = .33). No correlations were observed between age, height, weight, and BMI with antibiotic plasma levels. Conclusion: These findings demonstrate that plasma concentrations of a prophylactic dose of amoxicillin are higher than the minimum inhibitory concentration needed to prevent the common dental bacteria involved in peri-implantitis and periodontal diseases. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate a new minimally invasive surgical technique for the reconstruction of critical-size bony defect with local harvested bone core with simultaneous implant placement. In a prospective study, 186 consecutively treated patients were included and controlled clinically and radiologically for at least 5 years postoperative. Every patient presented a bony defect affecting the buccal, lingual, or palatal wall. In all cases, the alveolar crest was wide enough to allow implant placement inside the bony contours. During implant bed preparation, a trephine bur (3.5 mm external diameter and 2.5 mm internal diameter) was used to harvest a bone core from the socket. After implant insertion, the buccal/palatal/lingual bony defect was grafted with bone chips covered with the bone core stabilized through compression with microscrews. After 3 months of healing, the implants and the grafted bone were exposed and the width of the grafted area was measured. After prosthetic restoration, the patients were recalled regularly. A total of 223 grafted sites were documented. Minor primary healing complications were observed in 3 sites (1.4%), all in smoker patients, and were treated locally without any influence on the prognosis. All other sites healed uneventfully. In 19 cases (4.4%), exposure of the screw heads was detected 1 to 3 months postoperatively without any inflammation or consequences for the grafted bone. The average width of the reconstructed area at the end of the grafting procedure was 2.4 ± 0.8 mm, and at the reentry, 2.1 ± 0.6 mm. There was a difference of remodeling between bone cores grafted totally inside or partially outside the bony contours. Bone cores grafted completely inside the bony contours demonstrated no resorption at 3 months postoperative, while bone cores grafted partially outside the bony contours in most cases showed partial resorption of the bone outside the bony contours. After 3 months of healing, all 223 implants had achieved primary healing and osseointegration and were restored after an average time of 4 months. No implant failed during the control period. According to this study, the use of an autogenous bone core harvested during the implant bed preparation is a simple and safe method for the reconstruction of small bone defects. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to examine the histories of 100 patients with 170 implants that were consecutively treated and reported in a previous study to identify which patient and implant factors might have affected the outcomes of therapy. Patient factors included history of periodontitis, hypertension, cardiac problems, rheumatoid arthritis, smoking, and penicillin allergy. Implant factors included whether the prosthesis was cemented or screw retained and initial bone loss (≤ 50% or > 50% of implant length). Frequency of maintenance visits (≤ 3 months or > 3 months) were recorded, as was patient age (≤ 60 years or > 60 years). On the patient level, only postoperative maintenance (≤ 3 months) showed a statistically significant effect on radiographic bone gain (RBG) compared to patients with > 3 months maintenance frequency. Nondiabetic patients showed a trend toward soft tissue gain. On an implant level, screw-retained prostheses demonstrated a statistically significant RBG compared to those with cement-retained prostheses. Significant favorable differences were seen in all outcomes when evaluating presurgical bone level loss (> 50% of the implant length). Further studies with larger groups of patients are necessary to substantiate the findings in this report. [ABSTRACT FROM AUTHOR]

This report describes a failed blade implant after 25 years in function in the left maxilla and the results of histologic analysis of peri-implant tissues. The blade was retrieved, and histologic findings revealed that it was not osseointegrated despite being successfully in function for so many years. The long-term function of blade implants without osseointegration can be attributed to biotolerance exhibited by the implant rather than actual osseointegration. [ABSTRACT FROM AUTHOR]

Purpose: To compare the qualitative and quantitative profile of Epstein-Barr virus (EBV) at external and internal implant surfaces between participants with peri-implantitis and healthy peri-implant tissues and to quantitatively assess the relation between EBV and periopathogens inside the microbiologic profile associated with peri-implantitis. Materials and Methods: Microbiologic specimens were retrieved from 84 patients wearing 190 implants to estimate the levels of EBV and 10 periopathogens in the peri-implant pocket and internal-implant connection using quantitative polymerase chain reaction. Results: The study sample consisted of 113 healthy and 77 peri-implantitis--affected implants. Statistical significance was not reached in EBV prevalence between peri-implantitis and healthy controls. EBV-positive participants demonstrated higher levels of Prevotella intermedia (Pi) and Campylobacter rectus (Cr) compared with EBV-negative participants. A positive correlation was demonstrated among EBV and Tannerella forsythia (Tf), Parvimonas micra (Pm), Fusobacterium nucleatum (Fn), and Cr levels in peri-implantitis--affected implants, while healthy controls demonstrated a positive correlation between EBV and Aggregatibacter actinomycetemcomitans (Aa), Pi, and Pm. Conclusion: EBV cannot be considered as a microbiologic marker of peri-implantitis. However, EBV could be considered as a risk factor and a peri-implantitis enhancer based on its positive correlations with pathogens associated with peri-implantitis. [ABSTRACT FROM AUTHOR]

Interest has recently developed in the purposeful retention of root fragments with their periodontal apparatus to support bone and soft tissue at immediate implant sites in the esthetic zone. This methodology is designed to avoid bone grafting, connective tissue grafts, and the use of membranes and may have short-term benefits in terms of tissue preservation. However, it is not completely without long-term risks. At times, implants may be unintentionally placed into edentulous sites where root fragments remain. This report presents two cases of long-term failure postloading associated with unintentionally retained root fragments. Histologic evaluation evidenced retained root fragments in close association with dental implants and the surrounding bone. Scanning electron microscopic evaluation revealed that the failed implant surfaces were infiltrated by bacterial deposits and calculus. Clinicians should exercise caution when placing dental implants in sites with retained root fragments, as long-term risks may be associated with this therapy. [ABSTRACT FROM AUTHOR]

Purpose: To identify whether reuse or replacement is better for managing loose screws. Materials and Methods: An electronic search was performed utilizing PubMed, and a further manual search of the reference lists of relevant reviews and articles was conducted. Selected inclusion and exclusion criteria were used to limit the search. Results: The electronic and manual search provided 243 titles and abstracts. Fulltext analysis was performed for 98 articles, resulting in a total of 15 articles that qualified for inclusion in this study. All the included articles reported that loose screws were reused and retightened or were replaced by new screws. The time of screw loosening ranged from 1 month to 3 years after delivery. Available details of numbers and frequency of screw loosening permitted only limited analysis from very few articles. A total of 44 loose screws reported in two articles did not loosen again after retightening once. Conclusion: From the very limited available literature, it appears that retightening an occlusal screw or abutment screw is an acceptable procedure, as the evidence shows that retightened screws seem to remain tight. Replacement of screws as a routine procedure cannot be recommended. Routine assessment of screw tightness is recommended to minimize additional and more severe complications. [ABSTRACT FROM AUTHOR]

Purpose: To report survival rate, early surgical template-related complications, and prevalence of periimplantitis of dental implants placed in private practices using computer-guided, template-assisted surgery and followed between 1 and 10 years. Materials and Methods: The present retrospective multicenter study evaluated data collected from fully or partially edentulous patients, with anodized-surface implants placed using computer-guided, template-assisted surgery between January 2006 and December 2015. The outcome measures were implant cumulative survival rate (CSR), early surgical complications involving the surgical template, and prevalence of peri-implantitis. Results: A total of 694 implants were placed in 141 patients. Ten patients (7.1%) with 48 implants (6.9%) dropped out during the study period. One hundred seventeen patients, who received 121 surgical and prosthetic procedures, were treated according to a double-scan protocol, while the remaining 24 patients were treated by using the integrated treatment workflow. Most of the implants were immediately loaded (528 implants, 76.1%; 112 patients, 79.4%). Overall, 107 complete full-arch restorations (supported by four to eight implants each) were delivered in 103 patients (73%) with 595 implants (85.7%), while 13 single and 30 partial restorations (two to five implants each) were delivered in 38 patients (27%) with 99 implants (14.3%). Patients were followed for up to 10 years (mean: 58.2 months, range: 12 to 120 months). Implant- and patient-level CSR (Kaplan-Meier estimation) at the 10-year follow-up was 97.4% (95% CI: 1.0309 to 0.9161) and 92.1% (95% CI: 1.1575 to 0.6836), respectively. All failed implants were lost before definitive prosthesis delivery (early failure). Ten (7.1%) minor template-related complications were experienced and resolved chairside. Over the entire follow-up period, four patients (2.8%) with 12 implants (1.7%) showed signs of peri-implantitis at the 1- (four implants), 2- (four implants), and 4-year (four implants) visits. Conclusion: High long-term survival rates and low complications and prevalence of peri-implantitis were observed for a large cohort of anodized-surface implants placed in private practices. Further studies are needed to confirm these preliminary results. [ABSTRACT FROM AUTHOR]

Purpose: To determine differences in marginal bone changes when using submerged or transmucosal dental implants through a systematic review of the literature. Materials and Methods: PubMed, Embase, and the Cochrane Library were electronically searched for trials comparing marginal bone loss between submerged and transmucosal dental implants with a minimum follow-up of 12 months published between January 1980 and January 2016. Manual searches of the bibliographies of the included studies were also carried out. Screening of titles and abstracts, data extraction from the included studies, and quality assessment following the PRISMA statement were conducted in duplicate. Outcome measures were radiographic marginal bone level changes, implant survival, prosthesis failure, prosthetic complications, and esthetics. Results: The search strategy identified a total of 4,991 studies. Two of the authors independently screened 855 abstracts, resulting in a total of 12 studies; however, the total included in the systematic review was 11, as 2 studies were based on data from the same patients and were therefore counted as 1. A total of 998 implants (413 submerged and 585 transmucosal) were observed in 542 patients. Seven of the studies had a randomized study design and a follow-up of 12 months; therefore, they were included in the meta-analysis of bone loss and implant survival. The overall estimate of the bone loss difference was -0.01 mm (95% confidence interval [95% CI] -0.11 to 0.09 mm), and there was less bone loss in the transmucosal implants than in the submerged implants (P = .811, I² = 63.7%). The estimated relative risk for implant loss at 12 months was 0.31 (0.09 to 1.09, P = .068, I² = 0%) in favor of the submerged healing protocol. Augmentation procedures seemed to be successful irrespective of the implant placement modality, but owing to few clinical data no evidence could be found. Because of the lack of clinical data, esthetic outcomes could be reported only in a descriptive way. Conclusion: In the present meta-analysis, no evidence was found of differences between submerged and transmucosal implant placement protocols with regard to changes in marginal crestal bone levels or implant survival at 12 months follow-up. Therefore, it can be concluded that in many clinical situations it seems questionable whether a closed healing protocol offers an advantage over a transmucosal protocol. [ABSTRACT FROM AUTHOR]

Purpose: Rotational errors of implants can occur during two stages: when connecting impression copings with implants, and when connecting impression copings with analogs. The aim of this study was to determine ways to minimize these rotational errors. Materials and Methods: Three types of implants were prepared: a tissue-level implant with an internal octagon 8-degree Morse taper connection, a bone-level implant with an internal hex 11-degree Morse taper connection, and a bone-level implant with an external hex connection. Each complex (n = 10 per group) was composed of an implant, an impression coping, and an analog. Implants were embedded in resin blocks and connected with corresponding impression copings. Analogs that reproduced the position of the implants were created by means of a custom-made transfer jig, and rotational errors were measured between implants and analogs. Impression copings and analogs were connected by means of four methods: The impression coping was connected to the implant in a clockwise (CW) or a counterclockwise (CCW) direction before tightening, and the analogs were then connected with impression copings and tightened using a hemostat (Hs) or by hand (Hd). Results: The CW-Hs and CCW-Hd groups exhibited low rotational error (mean ± standard deviation 0.11 ± 0.21 and 0.19 ± 0.34 degrees, respectively), whereas the CW-Hd and CCW-Hs groups exhibited high rotational error (-1.80 ± 0.67 and 2.07 ± 0.75, respectively) in different directions. A strong association was observed between the tightening method and rotational error, and a weak association was observed between the connection type and rotational error. Conclusion: The CW-Hs method was found to be the most suitable for minimizing rotational error between implants and analogs. [ABSTRACT FROM AUTHOR]

Purpose: Achievement of high insertion torque values indicating good primary stability is a goal during dental implant placement. The objective of this study was to evaluate whether or not two-piece implants made from zirconia ceramic may be damaged as a result of torque application. Materials and Methods: A total of 10 two-piece zirconia implants were repeatedly inserted into polyurethane foam material with increasing density and decreasing osteotomy size. The insertion torque applied was measured, and implants were checked for fractures by applying the fluorescent penetrant method. Weibull probability of failure was calculated based on the recorded insertion torque values. Results: Catastrophic failures could be seen in five of the implants from two different batches at insertion torques ranging from 46.0 to 70.5 Ncm, while the remaining implants (all belonging to one batch) survived. Weibull probability of failure seems to be low at the manufacturerrecommended maximum insertion torque of 35 Ncm. Chipping fractures at the thread tips as well as tool marks were the only otherwise observed irregularities. Conclusion: While high insertion torques may be desirable for immediate loading protocols, zirconia implants may fracture when manufacturer-recommended insertion torques are exceeded. Evaluating bone quality prior to implant insertion may be useful. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical outcomes and complications related to provisional prostheses after fullarch implant-supported rehabilitation by means of an immediate loading protocol. Materials and Methods: This retrospective cohort study included patients who were consecutively treated with full-arch implantsupported restorations with a minimum of four implants (Replace Select Tapered TiUnite, Nobel Biocare AB) per arch and conical abutments (multi-unit, Nobel Biocare AB) by means of an immediate loading protocol. The surgical procedures were performed between May 2006 and June 2014 by a single oral surgeon. Demographic, surgical, and prosthetic variables were collected, and biologic and mechanical complications were registered. Results: A total of 61 maxillae (57%) and 46 mandibles (43%) were treated in 88 patients (40 men and 48 women) with a mean age of 62.4 years. A total of 558 implants were placed, 295 in postextraction sockets. A total of 331 implants (59.3%) were placed in the maxilla and 227 (40.7%) in the mandible. Within a 9-month period, 18 prostheses (16.8%) fractured (15 maxillary and 3 mandibular); in nine of these patients the opposing dentition was a full-arch, implant-supported restoration, and in the remaining nine patients, it was natural dentition. Six (1.1%) maxillary and three (0.5%) mandibular implants failed. Conclusions: A high implant survival rate is expected in the short term following this immediate loading protocol. Fracture of the provisional prosthesis is a common finding, affecting 17% of patients, and is significantly more prevalent in patients with bruxism and in maxillary prostheses. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the biochemical composition of bone nodules deposited by gingival mesenchymal stem cells (GMSCs) over titanium machined surfaces in vitro. Materials and Methods: GMSCs were isolated from healthy gingival tissues of patients undergoing crown-lengthening surgical procedures. GMSCs were characterized following the International Society for Cellular Therapy guidelines. After incubation of the GMSCs with titanium discs, osteogenic differentiation was induced for 28 days. Osteogenic lineage was confirmed by means of Alizarin Red S staining. Bone nodule morphology and deposition by GMSCs were characterized by scanning electron microscopy (SEM). An elemental analysis of the bone nodules was done using energydispersive x-ray spectroscopy (EDS). The biochemical composition of these nodules was further characterized via Raman spectroscopy, with native alveolar bone used as a control. Results: GMSCs adhered and proliferated on the titanium discs and exhibited a spindle-shaped fibroblast-like morphology under standard culture conditions. Their phenotype was confirmed by the expression of CD105, CD90, CD73, and CD146, observed using flow cytometry. Deposits of calcium bone nodules were evident in the cultures after staining with Alizarin Red S, but were absent in the controls. Calcium and phosphate, the major components of hydroxyapatite, were present in the bone nodules, as shown by means of the EDS analysis. The results obtained from Raman spectra of these nodules showed the phosphate ions (v[PO43-], ~960 cm¹), amide III (δ[NH], ~1,245 cm-1), CH2 scissors (~1,451 cm-1), amide I (v[C = O], ~1,667 cm-1), and v(CH) (2,800-3,100 cm-1) bands were similar to those observed in native bone. Conclusion: GMSCs can deposit a bone-like mineral highly similar to native bone (HA) over titanium surfaces. Ongoing studies are aimed at determining whether GMSCs can deposit a similar bone matrix/tissue over removed failed dental implants. If HA can be placed over removed failed dental implants, it may be possible to re-osseointegrate dental implants that are failing as a result of periimplantitis in vivo. [ABSTRACT FROM AUTHOR]

Purpose: The correlation between associated local factors and peri-implantitis remains unknown. The aim of this study was to investigate the association between the clinical and microbiologic profiles and periimplantitis to eventually categorize different groups of this disease. Materials and Methods: Subjects with at least one implant presenting signs of peri-implantitis were selected. The clinical, radiographic, occlusal, and microbiologic profiles of these infected implants were collected. Cases were classified into five peri-implantitis groups according to potential disease-triggering factors: surgically, prosthetically, biomechanically, purely plaque-associated, and a combination of them. Generalized estimating equations models were used to study differences among the potential risk factors. Cluster analyses were applied to investigate the correlation between clinical and microbiologic profiles and diseased implant samples. Results: Overall, 110 diseased and 121 healthy implants were included. The biomechanically associated group showed higher levels of microbiologic contamination inside the connection; however, the plaque-associated group had a higher level of microbial variety in the peri-implant sulcus. Cluster analyses demonstrated a significant ability to predict the associated factor of peri-implantitis. Moreover, radiographic marginal bone loss and implant width demonstrated the largest influence on the model. Conclusion: While peri-implantitis represents a plaqueinduced inflammatory condition, certain local factors might be associated with this biologic complication, as they imply plaque retention. Therefore, disease classification could be further implemented with the associated surgical, prosthetic, and biomechanical factors to better target the etiology. [ABSTRACT FROM AUTHOR]

Purpose: Outcome research has become an increasingly important form of clinical evidence for making health care decisions, including oral health considerations in the field of dentistry. In oral reconstruction involving dental implants, the risk of implant failure may be influenced by a patient's underlying medical condition. To identify associations, implant failure and systemic conditions or diseases were studied in a consecutive series of patients who received dental implants from October 1, 1983, to December 31, 2014, in the Department of Dental Specialties at Mayo Clinic in Rochester, Minnesota. Materials and Methods: Data were abstracted from a prospective clinical database and electronic health records for patients' demographic, implant-specific, and medical profiles to determine time to first implant failure. Survival free of implant failure at the patient level was estimated by using the Kaplan-Meier method. Associations of demographic and systemic characteristics with implant failure were evaluated by using Cox proportional hazards regression models and summarized with hazard ratios and 95% confidence intervals. Results: The patient cohort consisted of 6,358 patients with a median age of 53 years at placement of the first implant. A total of 713 patients experienced implant failure at a median of 0.6 years. Among the 5,645 patients who did not experience implant failure, the median duration of follow-up was 5.8 years. More than 20 systemic diseases or conditions were identified for assessment, of which 15 comprised more than 50 patients and five comprised more than 500 patients. All associations were adjusted for age, sex, and era of implant, given the strong influence of these features on implant failure. After adjustment, no systemic disease or condition was shown to increase the risk for implant failure in the population and setting studied. Conclusion: Patients considering oral reconstruction involving implants in the medical setting studied do not appear to risk implant loss because of systemic conditions or diseases. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the association between the intake of proton pump inhibitors (PPIs) and the risk of dental implant failure. Materials and Methods: The present retrospective cohort study is based on patients consecutively treated between 1980 and 2014 with implant-supported/retained prostheses at one specialist clinic. Modern endosseous dental implants with cylindrical or conical design were included, and only complete cases were considered; ie, only those implants with information available for all variables measured were included in the regression model analysis. Zygomatic implants and implants detected in radiographies but without basic information about them in the patients' files were excluded from the study. Implant- and patient-related data were collected. Multilevel mixed-effects parametric survival analysis was used to test the association between PPI exposure (predictor variable) and risk of implant failure (outcome variable), adjusting for several potential confounders. Results: A total of 3,559 implants were placed in 999 patients, with 178 implants reported as failures. The implant failure rates were 12.0% (30/250) for PPI users and 4.5% (148/3,309) for nonusers. A total of 45 out of 178 (25.3%) failed implants were lost up to abutment connection (6 in PPI users, 39 in nonusers), with an early-to-late failure ratio of 0.34:1. The intake of PPIs was shown to have a statistically significant negative effect for implant survival rate (HR 2.811; 95% CI: 1.139 to 6.937; P = .025). Bruxism, smoking, implant length, prophylactic antibiotic regimen, and implant location were also identified as factors with a statistically significant effect on the implant survival rate. Conclusion: This study suggests that the intake of PPIs may be associated with an increased risk of dental implant failure. [ABSTRACT FROM AUTHOR]

Purpose: To assess the influence of several factors on the prevalence of dental implant failure, with special consideration of the placement of implants by different dental surgeons.Materials and Methods: This retrospective study is based on 2,670 patients who received 10,096 implants at one specialist clinic. Only the data of patients and implants treated by surgeons who had inserted a minimum of 200 implants at the clinic were included. Kaplan-Meier curves were stratified with respect to the individual surgeon. A generalized estimating equation (GEE) method was used to account for the fact that repeated observations (several implants) were placed in a single patient. The factors bone quantity, bone quality, implant location, implant surface, and implant system were analyzed with descriptive statistics separately for each individual surgeon.Results: A total of 10 surgeons were eligible. The differences between the survival curves of each individual were statistically significant. The multivariate GEE model showed the following variables to be statistically significant: surgeon, bruxism, intake of antidepressants, location, implant length, and implant system. The surgeon with the highest absolute number of failures was also the one who inserted the most implants in sites of poor bone and used turned implants in most cases, whereas the surgeon with the lowest absolute number of failures used mainly modern implants. Separate survival analyses of turned and modern implants stratified for the individual surgeon showed statistically significant differences in cumulative survival.Conclusion: Different levels of failure incidence could be observed between the surgeons, occasionally reaching significant levels. Although a direct causal relationship could not be ascertained, the results of the present study suggest that the surgeons' technique, skills, and/or judgment may negatively influence implant survival rates. [ABSTRACT FROM AUTHOR]