Proliferative verrucous leukoplakia (PVL) is a non-homogenous type of oral leukoplakia, characterized by multifocal white plaques, propensity to recur after treatment, with strong tendency towards malignant transformatio...Proliferative verrucous leukoplakia (PVL) is a non-homogenous type of oral leukoplakia, characterized by multifocal white plaques, propensity to recur after treatment, with strong tendency towards malignant transformation. Interestingly, some studies show that, at initial stages, PVL may resemble oral lichen planus (OLP), potentially leading to misdiagnosis. A 52-year-old woman, with a previous OLP diagnosis, was referred to our service for implant installation and follow-up of OLP lesions. After clinicopathological re-evaluation, a diagnosis of PVL (early stage) was made, and a maxillary full-arch implant-supported prosthesis supported by implants was installed. After 6 years of follow-up, the patient developed squamous cell carcinoma around the implants. The current case emphasizes that PVL patients with oral lesions suggesting peri-implantitis or peri-implant mucositis deserve a more meticulous investigation.
In this case report, a new modified technique is described for an efficient, simple, and effective digital approach to immediate provisionalization of the implant-supported full-arch prosthesis. Today's patient populatio...In this case report, a new modified technique is described for an efficient, simple, and effective digital approach to immediate provisionalization of the implant-supported full-arch prosthesis. Today's patient population is increasingly educated about treatment options and expects efficient, esthetic, and comfortable results. This novel technique delivers on these aims while eliminating the many challenges posed by previously described digital and analog techniques to the immediate provisionalization of the implant-supported full-arch prosthesis. This technique requires minimal chair time and cost to the provider and reduces patient discomfort and complication risk. This technique therefore presents a promising new protocol for this popular procedure.
The optimal scan pattern for full-arch digital implant impressions remains to be determined. This study aimed to analyze the effects of different scan patterns on the trueness of intraoral scanners for full-arch digital...The optimal scan pattern for full-arch digital implant impressions remains to be determined. This study aimed to analyze the effects of different scan patterns on the trueness of intraoral scanners for full-arch digital implant impressions. A maxillary plaster model with 4 implant analogs was employed as the master model. Scan bodies were attached to the master model and scanned with a laboratory scanner to obtain reference data. Test scans were obtained using 3 different scan patterns with Cerec Primescan and Trios 3. Each test datum was superimposed onto the reference data. The trueness was assessed by determining the 3D distance and angular deviations between the test and reference data. Significant differences in 3D distance deviation were detected among the scan patterns for both scanners. Significant differences in angle deviation were detected among the scan patterns for the Cerec Primescan, whereas it was not substantial for the Trios 3. Cerec Primescan exhibited superior trueness across all scan patterns compared with Trios 3. The zigzag pattern resulted in more accurate scans for the Cerec Primescan, whereas both the zigzag and occlusal-palatal-buccal patterns showed higher accuracy for the Trios 3.
Perforation of the maxillary sinus membrane is a common complication during maxillary sinus elevation. Intraoperative perforation of the maxillary sinus membrane may complicate the procedure and indirectly lead to implan...Perforation of the maxillary sinus membrane is a common complication during maxillary sinus elevation. Intraoperative perforation of the maxillary sinus membrane may complicate the procedure and indirectly lead to implant failure. Timely repair of the perforated maxillary sinus membrane can effectively improve the implant survival rate. This case describes a method of repairing a maxillary sinus membrane perforation with a suture-attached collagen membrane and shows stable repair results at a 31-month follow-up.
The present study aims to evaluate the trends of oral implant-related research in design and topics between the range of 2016 to the end of 2022. The electronic search was conducted in MEDLINE via Pubmed. Papers publishe...The present study aims to evaluate the trends of oral implant-related research in design and topics between the range of 2016 to the end of 2022. The electronic search was conducted in MEDLINE via Pubmed. Papers published in Clinical Oral Implant Research, Clinical Implant Dentistry and Related Research, and International Journal of Oral Implantology as well as previously European Journal of Oral Implantology, International Journal of Oral and Maxillofacial Implants, and Journal of Oral Implantology between January 1, 2016, and December 30, 2022, were retrieved. Articles were classified according to their study design and major subjects. The Joinpoint regression model was used to determine changes in the trends of study designs and topics. Statistical significance was defined as a p-value <.05. A total of 3382 articles were analyzed in this study. In the specified period, in vivo, prospective cohort, retrospective case control, randomized clinical studies in the design and prosthetic complications, peri-implant hard tissue studies in the topic experienced a significant decreasing pattern in the number of published articles as well as the total number of articles. Case reports and series, retrospective cohort, nonrandomized clinical studies in the design and outcomes of implant-related treatment plans, immediate implant placement, and peri-implantitis in the topic experienced a significant decreasing pattern followed by a significant increasing pattern with a turning point between 2017 and 2020. Considering the limitations of this scientific topical trend analysis, it can be concluded that the recent pandemic affected the research path in oral implantology in many ways.
Although transcrestal sinus floor elevation (TSFE) is widely used for cases of insufficient residual bone height in the posterior maxilla, few studies focus on the risk factors of early implant failure associated with TS...Although transcrestal sinus floor elevation (TSFE) is widely used for cases of insufficient residual bone height in the posterior maxilla, few studies focus on the risk factors of early implant failure associated with TSFE procedures. This study aimed to identify and summarize the possible risk factors of implant failure associated with TSFE to ensure a more predictable implant survival rate using TSFE. We report the treatment of a patient with implant failure following TSFE and discuss this case's possible associated risk factors. A standard implant with a diameter of 4.8 mm and length of 10 mm was used after the TSFE procedure. Implant loosening was suddenly observed 6 weeks after the initial surgery. Factors that could result in early implant failure included patient-related risk factors, anatomical factors of the operational area, and operation- and implant-related factors. Within the current study's limitations, the graft material particles between the implant surface and socket could be considered a direct risk factor resulting in implant failure. Therefore, more attention should be paid to socket cleaning during the TSFE procedure, and loose particulate grafting materials should be discouraged. Another significant consideration for implant loss is the possibility of fractures in the buccal or palatal cortical plates during the site preparation and implant insertion. Thus, these factors should be studied further and receive more clinical attention.
We evaluated the effect of periosteal-releasing incisions on flap displacement in anterior maxillary sites following implant placement and simultaneously guided bone regeneration. Thirty patients, each requiring a single...We evaluated the effect of periosteal-releasing incisions on flap displacement in anterior maxillary sites following implant placement and simultaneously guided bone regeneration. Thirty patients, each requiring a single dental implant and guided bone regeneration in the maxillary esthetic zone, were recruited. After full-thickness flap elevation, the displacement of the flap was measured under a standardized tension of 1 Ncm. Then, a 2-step periosteal releasing incision was placed in the internal aspect of the flap, and the displacement was remeasured using the same standardized tension. Keratinized tissue width and mucosal thickness at the surgical site were recorded. Patient-reported outcomes were assessed at the 7- and 14-day recall visits. Flap displacement (primary outcome) was calculated before and after periosteal-releasing incisions. Multivariable linear regression models were used to evaluate the influence of mucosal thickness on flap displacement and adjusted for Keratinized tissue width. Primary wound closure was achieved in all patients. The mean difference in flap coronal displacement before and after the periosteal-releasing incisions was 8.2 mm (p < .0001). Adjusted regression models showed no association between mucosal thickness and keratinized tissue width with the amount of flap displacement (p = .770). Patient-reported outcome measures for pain, swelling, and bleeding amounted to 1.28 ± 1.93, 1.36 ± 1.87, and 0.0 ± 0.0 at 7 days and 0.11 ± 0.57, 0.56 ± 1.03, and 0.0 ± 0.0 at 14 days, respectively. Periosteal-releasing incisions using the 2-step procedure described here are a predictable technique to obtain coronal flap displacements >8 mm without increased surgical complications.
There were only a few studies investigating the effect of sagittal root position (SRP), sagittal root angle (SRA), and buccal bone thickness (BBT) on peri-implant tissues using the socket shield technique (SST). This ret...There were only a few studies investigating the effect of sagittal root position (SRP), sagittal root angle (SRA), and buccal bone thickness (BBT) on peri-implant tissues using the socket shield technique (SST). This retrospective case series aimed to evaluate the SRP, SRA, and BBT in socket shield cases and examine the effect of these anatomical factors on the peri-implant tissue phenotype and bone level. Data from 27 patients (14 women, 13 men) treated with SST in the maxillary esthetic region between July 2019 and September 2021 were included. Clinical indices (modified plaque and bleeding indices, probing depth, keratinized mucosa width, mucosal thickness) and periapical radiographic recordings (marginal bone level) taken immediately after permanent prosthesis placement and 1 year later were used. Cone beam computerized tomography images were used to examine BBT, SRP, and SRA before implant placement and horizontal and vertical bone levels before implant placement and 1 year after prosthetic rehabilitation. The data were divided into groups based on BBT (<1 and ≥1 mm) and SRA values (<10° and ≥10°). There were no significant differences in 1-year clinical factors between the SRA <10° and SRA ≥10° groups. However, higher vertical bone loss was found in the SRA ≥10° group (P = .01, d = 0.53). There were no significant differences in clinical or radiographic factors between the BBT <1 mm and BBT ≥1 mm groups. In conclusion, BBT showed no significant effect on tissue phenotype and bone level, but SRA affected bone level in socket shield cases.
The most challenging and time-consuming step in the free gingival graft (FGG) for keratinized mucosa augmentation is the compression suture anchoring the FGG to the periosteum. This article proposed a novel "microscrew w...The most challenging and time-consuming step in the free gingival graft (FGG) for keratinized mucosa augmentation is the compression suture anchoring the FGG to the periosteum. This article proposed a novel "microscrew with tie-down sutures" technique to anchor the FGG to the recipient site without the traditional trans-periosteum suture. This patient's keratinized mucosa width (KMW) around the healing abutments of teeth #29 and #30 was less than 1 mm. After an apically positioned flap (AFP) was prepared, 2 microscrews were placed at the buccal plate of the alveolar ridge bone, which is the coronal margin of the AFP. Then, the sutures winded between the microscrews and the healing abutments to anchor the FGG. In conclusion, the "microscrew with tie-down sutures" technique offers a feasible and straightforward alternative for the trans-periosteum compression suture, mainly when the periosteum is fragile, thin, or injured.
The present study aims to assess the feasibility of implant rehabilitation in kidney-transplanted patients. Patients with kidney transplantation included in periodontal supportive care and at least one year of dialysis w...The present study aims to assess the feasibility of implant rehabilitation in kidney-transplanted patients. Patients with kidney transplantation included in periodontal supportive care and at least one year of dialysis with mono- or partial edentulism were eligible for this study. Histomorphometric evaluation of the harvested bone was matched with radiological bone assessment. Implant stability was also monitored with resonance frequency analysis and insertion torque value. Fixed cemented prostheses have been delivered after conventional loading protocol. Supportive periodontal therapy has been administered. Eleven patients (9 males and 2 females) were included. The mean age was 58.1 ± 9.9 years. A total of 17 implants were inserted and analyzed. Mean ITV was 39.3 ± 23.8 Ncm. The mean primary stability (implant stability quotient) at T0 was 71.7 ± 10.5, whereas the mean secondary stability at T1 was 73.0 ± 7.3. The minimum follow-up was 62 months, with a maximum of 84 months (7 years) reached by 4 patients. Fourteen out of 15 implants were in function at a 5-year follow-up (survival rate: 93.3%). Two implants showed peri-implantitis. Seventeen bone samples were collected (13 in the mandible and 4 in the maxilla). The mean percentage of marrow spaces and lamellar bone was 41.6% and 58.4%, respectively. Class 3, according to Misch classification, was found as the mean value of radiological bone density. It can be concluded that implant-supported rehabilitation in kidney-transplanted patients is possible. Adequate periodontal maintenance allows implant rehabilitation in kidney-transplanted patients with long-term sufficient survival rates.
This case report aims to present the successful restoration of the atrophic partially edentulous posterior mandible using custom-made subperiosteal implants. The fixed prosthesis restoration was achieved using computer-a...This case report aims to present the successful restoration of the atrophic partially edentulous posterior mandible using custom-made subperiosteal implants. The fixed prosthesis restoration was achieved using computer-aided design and computer-aided manufacturing technologies and 3D metal printing methods. The partially edentulous 58-year-old patient expressed a preference not to undergo bone augmentation procedures. The patient with teeth in the anterior mandible was treated with 2 separate custom-made subperiosteal implants. A custom-made implant was fabricated from sintered titanium using machined subperiosteal implants with a universal external connection. Subperiosteal implants offer several advantages over conventional bone grafting plus intraosseous implant placement techniques, such as the simple, 1-step procedure for atrophic jaws, streamlining the treatment process and reducing the overall time involved. Treatments using subperiosteal implants can be an alternative solution for individuals with severely atrophic jaws. Longer term studies in a larger sample are warranted to corroborate previous reports.
The aim is to compare the resistance to torsion between 2 implant systems with internal hexagon connection: one using screw-retained abutments (Titanium Fix) and the other using cementable abutments (ITEC) under a tangen...The aim is to compare the resistance to torsion between 2 implant systems with internal hexagon connection: one using screw-retained abutments (Titanium Fix) and the other using cementable abutments (ITEC) under a tangential load. An in vitro experimental study was carried out. Fourteen implants, 7 implants from each system, were included in this study. The implants were placed at a 45° angle into metal blocks to simulate their position in the maxilla. Then, implants were subjected to a resistance test on a CMT5L universal testing machine, and the maximum load was applied to each sample. The maximum force with which the torsion was achieved in each sample was analyzed. The data were tested using the Shapiro-Wilk test and showed normal distribution. Student t test was used to examine statistical significance between the two groups, and the P value was set at P < .05. There was a statistically significant difference between the two groups (P = .001). ITEC implants with a cementable abutment showed greater flexural strength compared to the Titanium Fix with a screwed abutment implant system. The cemented abutment showed more resistance to torsion against a tangential load compared with the screwed abutment.
We present a case of an infection on a zygomaticus implant presenting on the skin, mimicking a cutaneous carcinoma, and presenting to a head and neck tumor board. The clinical findings were an intermittently discharging...We present a case of an infection on a zygomaticus implant presenting on the skin, mimicking a cutaneous carcinoma, and presenting to a head and neck tumor board. The clinical findings were an intermittently discharging lesion over the zygomatic bone, which resolved upon removing the offending zygomaticus implant. It is essential to be aware that infections on a zygomaticus implant can occur well away from the normal tooth-bearing areas, and having a dentist with knowledge of these implants on a tumor board can prevent misdiagnosis and treatment.
Bone grafting serves to restore the alveolar bone defect, providing adequate alveolar bone essential for long-term implant survival. This retrospective study aimed to evaluate the success rate of guided bone regeneration...Bone grafting serves to restore the alveolar bone defect, providing adequate alveolar bone essential for long-term implant survival. This retrospective study aimed to evaluate the success rate of guided bone regeneration (GBR) bone grafting and investigate the survival rate of implants and the degree of marginal bone loss (MBL) around implants. Furthermore, the influence of confounding factors such as patient conditions, bone graft properties, and implant characteristics was assessed. This study was carried out on treatment outcomes of patients with implants between January 2007 and December 2016, using various graft materials, including autograft, allograft, and xenograft. In a mean follow-up of 70 months (range: 3-10 years), the overall success rate of bone graft (n = 80) was 100%, and the overall survival rate of implant (n = 107) was 97.2% (autograft: 100%, allograft: 100%, and xenograft: 92.9%; P = .03). Mean MBL up to 3 years after implant installation were similar among graft materials, with 0.84 ± 0.48 mm in autograft, 0.73 ± 0.42 mm in allograft, and 1.01 ± 0.59 mm in xenograft (P = .14). Posterior mandibular location had a significant influence on implant survival (P = .003). A significant association of MBL with several factors, including age >60 years (P = .03), both diabetes and hypertension (P = .02), without receiving adjunctive membrane (P = .04), loading within 3-6 months (P < .001), and screw-retained crown (P = .008), was confirmed. Our data substantiated that implant rehabilitation with GBR using autograft and allograft provides the most predictable results. The factors above should be carefully considered with xenograft to enhance long-term clinical outcomes.
Most edentulous patients prefer fixed restoration or detachable prostheses over conventional complete dentures. The case report aims to address and discuss the clinical and laboratory steps of implant-supported, bar-reta...Most edentulous patients prefer fixed restoration or detachable prostheses over conventional complete dentures. The case report aims to address and discuss the clinical and laboratory steps of implant-supported, bar-retained maxillary overdenture and mandibular implant-supported, metal-acrylic resin, screw-retained, fixed complete denture. Impression techniques and laboratory steps are discussed and demonstrated to minimize the postfabrication or insertion complication. It lets you achieve the passive fit of the prosthesis that maintains the osseointegration by reducing stress on implants and the surrounding bone.
Dental implants are increasing in prevalence as desirable options for replacing missing teeth. Unfortunately, implants come with complications, and animal models are crucial to studying the pathophysiology of complicatio...Dental implants are increasing in prevalence as desirable options for replacing missing teeth. Unfortunately, implants come with complications, and animal models are crucial to studying the pathophysiology of complications. Current murine model experiments can be lengthy, with 8 weeks of extraction socket healing before implant placement. Therefore, we aimed to investigate the efficacy of decreasing extraction healing time from 8 to 4 weeks in a dental implant mouse model. Thirty-one 3-week-old C57BL/6J male mice underwent maxillary first and second molar extractions followed by 8 (control) or 4 (test) weeks of extraction socket healing before implant placement. Mice were euthanized after 4 weeks of implant osseointegration. Samples were analyzed via microcomputerized tomography and histology. When mice received implants 4 weeks after extractions, there was no statistical difference in initial bone crest remodeling or surrounding bone volume compared to those after 8 weeks of healing. Histologically, the hard and soft tissues surrounding both groups of implants displayed similar alveolar bone levels, inflammatory infiltrate, osteoclast count, and collagen organization. A 4-week extraction healing period can be utilized without concern for osseointegration in a murine implant model and is a viable experimental alternative to the previous eight weeks of healing. While small animal implant models are less directly applicable to humans, advancements in experimental methods will ultimately benefit patients receiving dental implants through improved prevention and treatment of complications. Subsequent research could investigate occlusal effects or whether healing time affects prognosis after induction of peri-implantitis.
When edentulism is accompanied by an impacted tooth, conventional treatment usually involves traumatic tooth extraction, which would inevitably destroy the surrounding alveolar bone and cause unfavorable esthetics, espec...When edentulism is accompanied by an impacted tooth, conventional treatment usually involves traumatic tooth extraction, which would inevitably destroy the surrounding alveolar bone and cause unfavorable esthetics, especially for anterior teeth. Recently, implant placement through the impacted tooth or residual root has been proposed as an alternative to invasive extraction. A particular type of integration has been observed between dentin/cementum and titanium implant, while enamel-implant contact has not been reported. In this article, an implant was placed through the impacted maxillary central incisor, thereby avoiding an invasive extraction surgery. The buccal section of the tooth, including crown enamel, was retained in situ for buccal alveolar ridge preservation. The follow-up results were satisfactory, and a stable enamel-implant contact was observed. Combining with previous similar studies, this technique opens intriguing possibilities and brings fresh insight for the concept of dentointegration. More histological and clinical studies with long-term follow-up are warranted before endorsing this technique in routine application.
A systematic review was designed to investigate the effect of treatment with oral bisphosphonate (BP) on osseointegration of dental implants and the incidence of BP-related osteonecrosis of the jaw (BRONJ) in postmenopau...A systematic review was designed to investigate the effect of treatment with oral bisphosphonate (BP) on osseointegration of dental implants and the incidence of BP-related osteonecrosis of the jaw (BRONJ) in postmenopausal women. Multiple electronic databases, including MEDLINE (PubMed), EMBASE, and SCOPUS, were searched to find all eligible articles published since 1990. All titles and abstracts retrieved by searching information sources were evaluated independently by 2 authors against the eligibility criteria. The number of cases ranged from 11 to 235, and the number of controls ranged from 14 to 343. Alendronate was used in all other studies. Risedronate was used in 6 studies, while ibandronate was used in 4 studies. The number of implants in cases ranged from 25 to 1267, while in controls, the number of implants ranged from 28 to 1450. The time between the placement of implant and the follow-up visit ranged from 4-6 months to 8 years. The results show that out of 2582 placed implants, 50 (1.94%) failed in BP-treated patients. This is while out of 4050 placed implants, 188 (4.6%) failed in the non-BP group. The results from the meta-analysis demonstrated that BP therapy is significantly associated with increased implant failure rates (RR = 1.73 [95% CI, 1.03-2.83], P = .04). Overall, the qualitative assessment of this review suggests that oral treatment with BPs in postmenopausal women does not increase the rate of dental implant failure. Thus, further studies with larger sample sizes should compare BP and non-BP groups in regard to dental implants.
To compare histologically the percentage of bone formation 12-20 weeks after ridge augmentation using 2 different techniques. Tooth loss is associated with 3-dimensional bone remodeling and ridge atrophy. Ridge preservat...To compare histologically the percentage of bone formation 12-20 weeks after ridge augmentation using 2 different techniques. Tooth loss is associated with 3-dimensional bone remodeling and ridge atrophy. Ridge preservation procedures can prevent alveolar bone volume loss. Different techniques and materials are used to preserve the alveolar ridge. Computer-generated randomization software was used to assign 2 ridge preservation techniques for 11 extraction sites. In group I, type I bovine Achilles tendon collagen plugs with bioactive resorbable calcium apatite crystals (CPCAC) were placed, and in group II, cortico-cancellous bone chips (CCBC) mix and an expanded polytetrafluoroethylene (ePTFE) barrier membrane were placed. The histomorphometric studies were performed using a computer-based image analysis system (ImageJ 1.4, National Institute of Health, Bethesda, Md) to calculate the pixel area of bone tissue and the remaining bone graft material. The histomorphometric data were analyzed using a Student t test to compare the measurements between the 2 experimental groups. This parametric statistical test was employed to determine if there were any statistically significant differences in the quantitative histological parameters between the groups. The sockets that received CPCAC showed a lower (31.89%) percentage of native bone surface area compared with the CCBC group (43.87%). However, the difference was not statistically significant (P < .05). In addition, the CPCAC group showed evidence of foreign-body reaction. The CCBC graft covered with an ePTFE barrier may induce more bone formation with minimal inflammation in an extraction socket compared with a collagen plug with calcium apatite crystals. In addition, histological analysis of the CPCAC graft showed evidence of foreign-body reaction, which indicates a negative clinical impact.