This article aims to comprehensively address and discuss the thresholds for implant removal in cases of severe peri-implantitis. Electronic databases were searched comprehensively, electronically, and manually. Studies f...This article aims to comprehensively address and discuss the thresholds for implant removal in cases of severe peri-implantitis. Electronic databases were searched comprehensively, electronically, and manually. Studies focusing on criteria for explantation of dental implants were included and reviewed comprehensively. Based on the latest evidence, explanation thresholds were proposed. Moreover, the included studies were evaluated and summarized. Current guidelines for implant removal are primarily based on expert opinions rather than actual data. Standardized data encompassing the extent of peri-implant bone loss for assessing treatment outcomes after surgical intervention for peri-implantitis is scarce. Nevertheless, newly available data confirms a poor prognosis for implants with more than 50% bone loss. This supports the recommendation for implant removal in cases of more than 50% bone loss due to peri-implantitis. Implant mobility resulting from the total loss of osseointegration necessitates the removal of the implant. While probing depth provides information about disease severity, it should not be used as the sole diagnostic tool. In the decision-making process for treatment or explantation, factors such as the number of affected implants, the implant's position within the bony housing, intraosseous defect morphology, type of implant restoration, and patient characteristics should be considered. The removal of severely compromised dental implants with peri-implantitis and bone loss exceeding 50% is supported. Moreover, factors related to the restoration, the implant itself, and the patient must be considered when deciding whether to remove or salvage a compromised implant. Clear clinical guidelines for explanting dental implants in cases of severe peri-implantitis need to be included. This poses significant challenges to clinicians when determining whether to explant or treat dental implants compromised by substantial bone loss.
Maxillary defects resulting from oncologic resection pose significant challenges for oral rehabilitation, affecting function, aesthetics, and quality of life. Traditional implant-based solutions are often unfeasible due...Maxillary defects resulting from oncologic resection pose significant challenges for oral rehabilitation, affecting function, aesthetics, and quality of life. Traditional implant-based solutions are often unfeasible due to insufficient bone volume, necessitating alternative approaches. This case report presents a 54-year-old male who underwent a total maxillectomy for palatal squamous cell carcinoma, followed by chemoradiotherapy. A customized subperiosteal titanium maxillary implant (CSTMI) was designed using virtual surgical planning (VSP), stereolithographic (STL) models, and CAD/CAM technology. The CSTMI framework, incorporating endosseous implants, was secured to the orbital rims and pterygoid plates to optimize prosthetic stability and load distribution. The healing of the patient was uneventful, with no signs of inflammation or dehiscence. The prosthesis improved speech, swallowing, and oral function, significantly enhancing quality of life. At the one-year follow-up, minor screw loosening was successfully managed without complications. CSTMI represents a viable alternative for maxillary reconstruction in patients unsuitable for traditional implants, providing functional and aesthetic rehabilitation. Digital workflows, including VSP and CAD/CAM, are crucial for treatment precision. Long-term studies are needed to assess implant survival, biomechanical optimization, and clinical success.
Osteoradionecrosis (ORN) lesion, a significant late toxicity associated with radiotherapy for head and neck cancer, may serve as a suitable habitat for the accumulation of important oral pathogens, which may increase the...Osteoradionecrosis (ORN) lesion, a significant late toxicity associated with radiotherapy for head and neck cancer, may serve as a suitable habitat for the accumulation of important oral pathogens, which may increase the risk of implant-related infections and rehabilitation failures in patients with dental implants. This clinical report assessed the microbial profile on the ORN lesion, the dental implant located adjacent to the lesion and in the contralateral area, and the saliva of a patient attended dental service from a public cancer institute. The patient was subjected to surgical debridement of ORN but it persisted. This suggests that ORN lesions may serve as microbial reservoirs, posing a significant risk factor for biofilm-related oral infections.
This study compares the operational difficulty and patient-related outcomes of removing a dental implant or tooth root displaced into the maxillary sinus. The study was conducted on 19 patients [median age, 22 years; fem...This study compares the operational difficulty and patient-related outcomes of removing a dental implant or tooth root displaced into the maxillary sinus. The study was conducted on 19 patients [median age, 22 years; female, 8 (42.11%)] whose dental implants or tooth roots remained in the maxillary sinus for over 6 months. Nine patients had dental implants in their maxillary sinuses (Group 1), and 10 had tooth roots migrated into the maxillary sinus during tooth extraction (Group 2). All patients were operated on under local anesthesia. The maxillary sinus was accessed by opening a lateral bone window osteotomy on the sinus wall (Caldwell-Luc technique). Age, gender, operation time, smoking habit, duration after displacement, displacement region, operational difficulty reported by the surgeon and patient-related outcomes such as pain, swelling, postnasal drip, and nasal obstruction were collected retrospectively. The mean age was 43.47 years. The mean age of the patients in the Group 2 was significantly lower (P = .037). There was no statistically significant relation between the operational difficulty in groups. However, there was a statistically significant difference in operation time between groups. The mean total operation time for Groups 1 and 2 were 66.22 minutes and 35.4 minutes, respectively (P = .001). Patient-related outcomes such as pain after the operation, nasal obstruction, postnasal drip and facial swelling were not different between groups (P > .05). It was determined that the operation time for removing the dental implants from the maxillary sinus was longer than the tooth root. However, operational difficulty and patient-related outcomes were similar.
Loosening and fracturing of the central screw are common mechanical complications after implant restoration. However, the relationship between these complications and the repetitive tightening and loosening of the centra...Loosening and fracturing of the central screw are common mechanical complications after implant restoration. However, the relationship between these complications and the repetitive tightening and loosening of the central screw during the fabrication and maintenance of the implant-supported restorations remains unknown. The purpose of this study was to evaluate the torque loss after repetitive tightening and loosening of the central screws on implants with different diameters as well as the changes in the angle deviation of the central screw relative to the implant. Twenty implants were divided into 2 groups based on diameter: 3.7 mm (group A) and 4.5 mm (group B) with 10 implants in each group. Each group was subdivided into 4 subgroups: A1, A2, B1, and B2 (n = 5). A closing torque of 15 N.cm was applied to groups A1 and B1, whereas a closing torque of 35 N.cm was applied to groups A2 and B2. Reverse torque measurements were taken 10 times for each group. The angular deviation of the central screw relative to the implant was recorded, and the surface wear of the central screw was observed under a scanning electron microscope. The data were analyzed using repeated measures 2-way analysis of variance (α = 0.05). Torque loss showed a significant upward trend across all groups with increased tightening cycle (P < .05). Implant diameter significantly influenced torque loss with smaller diameters exhibiting greater torque loss (P < .05). In addition, the angular deviation of the central screw relative to the implant was not affected by different diameters (P > .05). Still, it was affected by the closing torque and the cycles of multiple tightening and loosening procedures (P < .05). Under a 35 N.cm closing torque, initial torque loss ranged from 9.12 N.cm to 10.98 N.cm. Peak torque loss occurred at the 10th cycle with 16.40 N.cm values for 3.7-mm implants and 12.42 N.cm for 4.5-mm implants. Repeated tightening and loosening procedures increased both torque loss and angular deviation. The diameter of the implant may impact the torque loss with a larger diameter showing less torque loss. To reduce the risk of potential complications, it is suggested that the number of tightening cycles for narrow-diameter implants be limited.
The apically exposed implant in the maxillary sinus may contribute to sinus inflammation during the early healing phase or afterward. The exposed surface of the implant can act as a reservoir for infectious agents. This...The apically exposed implant in the maxillary sinus may contribute to sinus inflammation during the early healing phase or afterward. The exposed surface of the implant can act as a reservoir for infectious agents. This case report presents 2 cases in which an intraoral approach was used to manage maxillary sinus infections related to exposed implants within the sinus. In both cases, bony access windows were created on the lateral wall of the sinus to reach the apically exposed portion of the implant. In case 1, mechanical (titanium curettes and a rotating titanium brush) and chemical decontamination (tetracycline HCl solution-soaked cotton pellets) were performed. In contrast, case 2 involved chemical decontamination performed only after removing inflammatory tissues and fluids. Following treatment, the patient's sinonasal symptoms completely resolved. Radiographic evaluations showed a significant reduction in mucosal thickening and bone formation around the exposed portion of the implant. Intrasinus decontamination may be viable for treating infected maxillary sinuses related to apically exposed implants. The current protocol should be verified in more cases with longer term follow-up.
Protrusion of the dental implant into the maxillary sinus is known to cause thickening of the sinus mucosa and bacterial sinusitis. However, there are many cases where protruded implants do not cause long-term complicati...Protrusion of the dental implant into the maxillary sinus is known to cause thickening of the sinus mucosa and bacterial sinusitis. However, there are many cases where protruded implants do not cause long-term complications clinically or radiologically. Questions arise about whether the protruding implant was exposed or covered with sinus mucosa. In the present case, lateral sinus floor elevation was planned on the maxillary sinus adjacent to the deeply protruded (6.5 mm) implant #13. The protruding implant was scheduled for removal. During sinus floor elevation through a lateral sinus window, there was no damage or perforation of the elevated sinus mucosa around the protruded implant, and the implant surface was visibly clean. This suggests that the protruding implant was covered with sinus mucosa and not exposed. Therefore, maxillary sinus augmentation can be performed without explantation or surface treatment of the protruding implant. Within the limitations of this case report, implants that are deeply protruded into the maxillary sinus can be covered with sinus mucosa.
It is essential to compare conventional dental implants (CDIs) and mini dental implants (MDIs). This systematic review evaluates the clinical and radiological outcomes of individuals receiving MDI-retained overdentures (...It is essential to compare conventional dental implants (CDIs) and mini dental implants (MDIs). This systematic review evaluates the clinical and radiological outcomes of individuals receiving MDI-retained overdentures (ODs) compared with CDI-retained ODs. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for the current systematic review. The PubMed, Scopus, and Cochrane databases were examined for evidence-based research articles addressing the clinical and radiological outcomes of MDI and CDI published from January 2013 to September 2024. Two independent specialists conducted an autonomous search and established predefined screening criteria. The risk of bias for randomized controlled trials (RCTs) was evaluated using the criteria established by the Cochrane Handbook for Systematic Reviews of Interventions for scientific merit. The informational database and manual searches produced 242 papers. Eight RCTs were examined after eliminating duplicates and organizing the publications according to the qualifying criteria. MDI-retained ODs have been shown to provide numerous benefits, including reduced bone resorption; enhanced esthetics, occlusion, and tooth location; improved occlusal load direction; and maintenance of occlusal vertical dimension. The current systematic review suggests that using MDIs to retain overdenture prostheses could be a viable alternative treatment option due to the high survival rates, acceptable marginal bone loss, and improvements in patient satisfaction and oral health-related quality of life metrics.
Traditionally, intrasocket granulation tissue (IGT) has been regarded as infected tissue to be removed during extraction to facilitate bone healing. However, recent findings suggest that IGT can support primary closure,...Traditionally, intrasocket granulation tissue (IGT) has been regarded as infected tissue to be removed during extraction to facilitate bone healing. However, recent findings suggest that IGT can support primary closure, preserving keratinized mucosa and enhancing healing potential without requiring additional soft tissue grafting. This case series explores the application of IGT as an extended flap in immediate implant placement within type III extraction sockets, specifically in the anterior maxilla of healthy patients. A dense, thick IGT was utilized to extend the gingival flap, achieving tension-free primary closure and maintaining mucogingival junction stability. This technique allowed for socket preservation with sufficient vestibular depth and reduced surgical intervention. Consequently, this approach may offer a viable alternative for immediate implantation in type III extraction sockets, particularly in esthetic areas in which keratinized mucosa and soft tissue stability are essential.
Natural teeth have a periodontal ligament with viscoelastic properties, while implants are connected to the bone with a strong connection and osseointegration; therefore, the stress on the adjacent bone of the implant an...Natural teeth have a periodontal ligament with viscoelastic properties, while implants are connected to the bone with a strong connection and osseointegration; therefore, the stress on the adjacent bone of the implant and its prosthetic components is more than that of natural teeth. This study examines the connection (Morse different tapers) to find the most suitable length and Morse angle of the taper and the angle of applying the force on the tooth to create the least stress using finite element analysis. Geometrical and 3D models of the mandible bone, implant, and its prosthetic components were made using engineering software and sizes of the DIO implant manufacturer. In this modeling, 4 types of connections with different lengths and tipping angles were designed, and then a constant force of 200 N was applied to them. Stress distribution was investigated in this experiment in 12 different conditions: 2 Morse taper lengths (1.3 mm and 2.6 mm), 2 Morse taper angles (11° and 16°), and 3 force application angles (0°, 30°, and 45°). By increasing the length of the Morse taper from 1.3 mm to 2.6 mm, the amount of stress in the bone adjacent to the implant and its prosthetic components is reduced. By increasing the tipping angle of the Morse taper from 11° to 16°, the amount of stress in the bone adjacent to the implant, the fixture, and the abutment decreases. Furthermore, by increasing the tipping angle of the morse from 11° to 16° the amount of stress in the implant screw increases. Increasing the angle of the force applied to the implant increases the amount of stress in the bone adjacent to the implant and its prosthetic components. The best Morse taper connection to create the least stress on the bone surrounding the implant and its prosthetic components is a long taper Morse with a length of 2.6 mm and a greater tipping angle (16°), This stress is less at the vertical force application angle.
Management of implant abutment screw loosening should go beyond simply retightening the abutment screw. This case report highlights the need to check all components for damage before disinfection and re-tightening if pos...Management of implant abutment screw loosening should go beyond simply retightening the abutment screw. This case report highlights the need to check all components for damage before disinfection and re-tightening if possible. Major concerns include the implant-abutment connection site, screw, and debridement of the internal implant surfaces. Scanning electron microscopy and optical microscopic exam of the debris removed after cleaning demonstrated the presence of titanium metal particles and biological materials. Protocols should be developed to address these issues before reattaching the implant restoration.
Extensive resections of the maxillary bone often result in significant defects that affect oral functions, such as speech and chewing. Although dentomaxillary prostheses are common, they frequently lead to instability an...Extensive resections of the maxillary bone often result in significant defects that affect oral functions, such as speech and chewing. Although dentomaxillary prostheses are common, they frequently lead to instability and reduced chewing ability. Vascularized bone grafts, including the fibula, are increasingly used to address these challenges due to their anatomical suitability and functional restoration benefits. Despite advances, problems remain, including insufficient bone height for stable implantation. A 60-year-old Japanese woman presented with swelling of the right maxilla and nasal obstruction and was diagnosed with osteosarcoma. Following chemotherapy and partial maxillary resection, she experienced discomfort with dentomaxillary prosthetics, prompting subsequent reconstruction with fibula and particulate cancellous bone and marrow (PCBM) grafts. This patient was taking methotrexate regularly for rheumatoid arthritis, so there was concern that she would be immunosuppressed. Therefore, we did not choose a zygomatic implant, which would be difficult to control in the event of infection. In addition, the fibula alone was insufficient for reconstruction; sufficient vertical and horizontal bone augmentation was required, and we chose a combination of titanium mesh and PCBM that met these requirements. Sequential implant procedures culminated in fixed superstructures that significantly improved occlusal function and prosthetic stability over a 6-year follow-up period. This case highlights the challenges of prosthetic instability following maxillary resections and demonstrates the effectiveness of multistage reconstructions using fibula grafts and PCBM for alveolar ridge augmentation. The structured approach to maxillofacial reconstruction provides valuable insights into optimizing functional outcomes following surgical procedures and highlights the importance of tailored treatment strategies in complex maxillofacial cases.
The objective is to describe a technique to protect the donor area after taking a free gingival graft. A partial de-epithelialization of the palatal area is performed with a lentil bur mounted in a dental turbine. A part...The objective is to describe a technique to protect the donor area after taking a free gingival graft. A partial de-epithelialization of the palatal area is performed with a lentil bur mounted in a dental turbine. A partial thickness flap is then created to harvest the superficial connective tissue layer. Subsequently, two collagen sponges are placed into the wound. The sponges are compressed and secured by two sling stitches. Once hemostasis is obtained, a uniform layer of flow composite is placed and light-cured. Finally, a sling stitch is added to secure and compress the composite layer. Postoperatively, the donor area showed satisfactory healing after 14 days, with partial healing after the first revision and complete epithelialization during the second revision, with no reported pain or discomfort. Thus, the patchwork technique may be a more straightforward, predictable, and cost-effective alternative that protects the donor area, improves healing, and reduces pain.
This pilot study evaluated and compared histomorphometric and immunohistochemical characteristics of peri-implant bone tissue after implant site preparation using piezoelectric tips versus conventional drills. Six patien...This pilot study evaluated and compared histomorphometric and immunohistochemical characteristics of peri-implant bone tissue after implant site preparation using piezoelectric tips versus conventional drills. Six patients with bilateral partial edentulism underwent a split-mouth protocol. Twelve alveolar ridges were randomized into 6 control implant sites prepared using conventional drills (drill group) and 6 test implant sites prepared using piezoelectric implant inserts (piezo group). At 28 days after surgery (T1), single-stage "study fixtures" with 0.5 mm of peri-implant bone tissue were explanted and processed for histological, histomorphometric, and immunohistochemical analysis in both groups. For each sample inflammatory infiltrates, necrotic bone (zone 1), woven and newly formed bone (zone 2), native bone (zone 3), a vascular endothelium differentiation and neo-osteogenesis marker (cluster of differentiation 31 [CD31]), and an osteoblastic cell differentiation and osteogenesis marker (special AT-rich sequence-binding protein 2 [SATB2]) were evaluated. According to their histological bone features, the 3 histologically distinct areas were evident in both groups: zones 1, 2, and 3 according to their histological bone features. Zone 1 showed lower extension in the piezo group than in the drill group (p = .028). Regarding the immunohistochemical markers, in all areas of the piezo group, SATB2 and CD31 were statistically higher than in the drill group. Implant site preparation using piezo surgery results in less bone necrosis, greater osteoblastic activity, and greater vessel proliferation compared with the conventional surgical approach.
The study aimed to investigate the influence of different gingival colors and abutment materials on the final color of peri-implant soft tissue. A total of 30-cylinder shaped specimens having 1.0- and 2.0-mm buccal thick...The study aimed to investigate the influence of different gingival colors and abutment materials on the final color of peri-implant soft tissue. A total of 30-cylinder shaped specimens having 1.0- and 2.0-mm buccal thicknesses using 5 different gingiva-colored composites [light pink (LP), dark pink (DP), orange (Or), brown (Br), and purple (Pr)] were prepared. Implants were placed straight into the center of cylinders and connected to abutments [Titanium (Ti) and Zirconia (Zr)]. Color parameters were assessed using a spectroradiometer. Color differences (ΔE*ab and ΔE00) were calculated and compared with 50:50% perceptibility (PT) and acceptability (AT) visual thresholds. Color variation data were statistically analyzed using 2-way analyses of variance followed by Tukey HSD tests (a = .05). Significantly higher ΔE*ab and ΔE00 values were recorded in LP and Or groups with 1.0 mm buccal thickness and Ti abutments (P < .05). Regardless of the thickness applied, all the gingival color groups with Zr abutment presented ΔE*ab and ΔE00 values below AT. The mean ΔE*ab value decreased as the gingiva thickness increased in the LP, DP, and Or groups with Ti abutments. Abutment material significantly affected the mean ΔE00 values in the groups of LP, DP, and Or with a buccal gingiva thickness of 1.0 mm (P < .05). Gingival color and abutment material was found to be effective on the final color of peri-implant soft tissue. However, further clinical research is required to confirm these findings.
This was a case report successfully employing the reverse scan technique. A 72-year-old male patient desired to restore his teeth in both jaws. Clinical examination revealed the presence of several remaining teeth with p...This was a case report successfully employing the reverse scan technique. A 72-year-old male patient desired to restore his teeth in both jaws. Clinical examination revealed the presence of several remaining teeth with poor prognosis due to significant bone loss and mobility. The treatment plan involved extracting these teeth, placing 4 implants in the maxilla and mandible, and fitting an interim immediate loading prosthesis. Full-thickness flaps were raised during surgery, and the remaining teeth were extracted. Implants and multiunit abutments were placed, followed by impressions and the recording of the interjaw relationship using index dentures. After 6 months of osseointegration, the reverse scan technique was employed, using light silicone, reverse scan bodies, and extraoral scanning to capture implant positions, soft tissue profiles, and prosthesis shapes. Titanium frames were machined for the final prostheses-monolithic zirconia for the maxilla and zirconia crowns with composite gingiva for the mandible. These were delivered after confirming the fit, aesthetics, and occlusion. The technique enhanced patient comfort, minimized chair time, and ensured the quality of the prosthetic outcome.