Evaluation of the treatment effect on sinus elevation and implant restoration in cases with odontogenic maxillary sinusitis after tooth extraction / 口腔疾病防治

Objective@#To investigate the clinical effects of sinus elevation surgery and implant restorationdue to insufficient bone massafter tooth extraction in patients with odontogenic maxillary sinusitis (OMS) and to provide a reference for use in clinical practice.@*Methods@#This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. Forty-five teeth were extracted from patients with OMS in the maxillary posterior area (the study group). Sinus elevation and implantation were performed due to insufficient bone height in the implant area 6-8 months after tooth extraction in the study group. Forty-eight teeth were extracted from patients without "OMS" in the maxillary posterior area (the control group), and sinus elevation and implantation were performed due to insufficient bone height in the implant area 6-8 months after tooth extraction inthe control group. In the study group, 13 cases of discontinuous maxillary sinus floor bone and residual alveolar bone height of the maxillary sinus floor less than 4 mm were addressed with lateral wall sinus elevation, and the other 32 cases were addressed with crest-approach sinus elevation. In the control group, 8 cases of residual alveolar bone height less than 4 mm in the maxillary sinus floor were addressed with lateral wall sinus,and the other 40 cases were addressed with crest approach sinus elevation. Restorations were placed 6 to 8 months after surgery. The patients were followed up 21 days, 3 months, and 8 months after implantation and every 6 months after the placement of the restorations. The sinus bone gain (SBG), apical bone height (ABL) and marginal bone loss (MBL) were statistically analyzed 24 months after the restoration.@*Results@#The average preoperative mucosal thickness in the 45 patients in the study group was (1.556 ± 0.693) mm, which was significantly larger than that in the control group (1.229 ± 0.425) mm (P<0.001). There were no perforations in either group. Twenty-four months after restoration, there was no significant difference in the SBG, ABH or MBL between the two groups (P>0.05).@*Conclusion@#After the extraction of teeth from patients with OMS, the inflammation of the maxillary sinus decreased, and the bone height and density in the edentulous area were restored to a certain degree. The effects of sinus floor lifting surgery and implant restoration do not differ between patients with and without OMS.

Novel mutations identified in the WNT10A gene and implant rehabilitation of patients with severe tooth agenesis / 口腔疾病防治

Objective@#To detect WNT10A gene mutations in patients with oligodontia or anodontia (≥6 teeth missing) and analyze their dental phenotype. @*Methods@#Patients with oligodontia or anodontia were enrolled from the clinic for oral examination, genetic history collection and whole exon sequencing, and patients with WNT10A gene mutations were included. Sanger sequencing was utilized to validate the WNT10A gene variations in probands and family members compared with the normal sequence. The pathogenicity of WNT10A mutations was evaluated by functional prediction, conservation analysis and structure prediction of protein mutants. Implant rehabilitation was applied to restore the patients' oral function.@*Results@# Five WNT10A gene mutations were detected in six unrelated patients, and c.26G>A (p. Trp9X) and c.1036delT (p. Cys346fs) were novel mutations with pathogenic potential. The mean number of missing teeth was (15.33±8.64) per case. The most frequently missing permanent teeth were maxillary canines (100%), and the least frequently missing teeth were mandibular first molars (25%). Implant rehabilitation was applied in five patients, and patients were found to have ideal implant osseointegration and functional restoration.@*Conclusion @# This study identified novel WNT10A gene pathogenic variants, enriching the WNT10A gene spectrum and providing new evidence for genetic diagnosis and prenatal consultation. Implant rehabilitation was also proven to be a treatment option for these patients.

Application of video education combined with Teach-back in implant restoration treatment of patients with chronic periodontitis / 中国实用护理杂志

Objective:To explore the application effect of video education combined with Teach-back in the treatment of patients with chronic periodontitis.Methods:Using non-simultaneous experimental research methods, From January to August in 2019, 41 patients with chronic periodontitis who underwent implant restoration in Shanghai Tenth People′s Hospital was selected by convenience sampling method as the control group, and implemented routine oral health education. From September 2019 to May 2020, 42 patients with chronic periodontitis who underwent implant restoration in Shanghai Tenth People′s Hospital were the observation group, and implemented video education combined with Teach-back. Compare the two groups of oral health care self-efficacy, periodontal clinical indicators, and the incidence of peri-implant mucositis.Results:Comparing 6 months and 12 months after implant restoration, the total scores of oral health self-efficacy and regular oral visits, correct brushing, and balanced diet in the observation group were 66.31 ± 4.32 and 67.19 ± 4.65, 22.04 ± 1.35 and 21.69 ± 1.82, 21.73 ± 1.65 and 22.64 ± 1.82, 22.54 ± 1.62 and 22.86 ± 1.74 respectively, which were higher than the control group 53.93 ± 4.78 and 54.09 ± 5.67, 17.02 ± 2.58 and 17.43 ± 2.16, 17.65 ± 1.74 and 18.54 ± 2.36, 19.14 ± 2.13 and 18.12 ± 2.58, the difference between the two groups at the two time points were statistically significant ( t values were 6.52-12.39, all P<0.05). And the PLI, mSBI, and PIS scores of the observation group were 0.80 ± 0.17 and 0.75 ± 0.14, 0.79 ± 0.19 and 0.81 ± 0.18, 2.08 ± 0.45 and 2.10 ± 0.53, respectively, which were lower than the control group 0.92 ± 0.19 and 0.99 ± 0.21, 1.03 ± 0.17 and 1.16 ± 0.21, 2.45 ± 0.68 and 2.62 ± 0.61, the difference between the two groups at the two time points were statistically significant ( t values were 2.93-8.16, all P<0.05). 12 months after, the incidence of mucositis around implants in the observation group was 7.14%(3/42), which was lower than 26.83%(11/41)in the control group ( χ2=5.73, P<0.05). Conclusions:Video education combined with Teach-back can improve the self-efficacy of oral health care during implant restoration treatment in patients with chronic periodontitis, improve oral health care behavior, thereby improving the periodontal condition around the implant and reducing the incidence of mucositis.

Expert consensus on the bone augmentation surgery for alveolar bone defects / 口腔疾病防治

@#Alveolar bone is an important anatomic basis for implant-supported denture restoration, and its different degrees of defects determine the choices of bone augmentation surgeries. Therefore, the reconstruction of alveolar bone defects is an important technology in the clinical practice of implant restoration. However, the final reconstructive effect of bone quality, bone quantity and bone morphology is affected by many factors. Clinicians need to master the standardized diagnosis and treatment principles and methods to improve the treatment effect and achieve the goal of both aesthetic and functional reconstruction of both jaws. Based on the current clinical experience of domestic experts and the relevant academic guidelines of foreign counterparts, this expert consensus systematically and comprehensively summarized the augmentation strategies of alveolar bone defects from two aspects: the classification of alveolar bone defects and the appropriate selection of bone augmentation surgeries. The following consensus are reached: alveolar bone defects can be divided into five types (Ⅰ-0, Ⅰ-Ⅰ, Ⅱ-0, Ⅱ-Ⅰ and Ⅱ-Ⅱ) according to the relationship between alveolar bone defects and the expected position of dental implants. A typeⅠ-0 bone defect is a bone defect on one side of the alveolar bone that does not exceed 50% of the expected implant length, and there is no obvious defect on the other side; guided bone regeneration with simultaneous implant implantation is preferred. Type Ⅰ-Ⅰ bone defects refer to bone defects on both sides of alveolar bone those do not exceed 50% of the expected implant length; the first choice is autologous bone block onlay grafting for bone increments with staged implant placement or transcrestal sinus floor elevation with simultaneous implant implantation. Type Ⅱ-0 bone defects show that the bone defect on one side of alveolar bone exceeds 50% of the expected implant length, and there’s no obvious defect on the other side; autologous bone block onlay grafting (thickness ≤ 4 mm) or alveolar ridge splitting (thickness > 4 mm) is preferred for bone augmentation with staged implant placement. Type Ⅱ-Ⅰ bone defects indicate that the bone plate defect on one side exceeds 50% of the expected implant length and the bone defect on the other side does not exceed 50% of the expected implant length; autologous bone block onlay grafting or tenting techniques is preferred for bone increments with staged implant implantation. Type Ⅱ-Ⅱ bone defects are bone plates on both sides of alveolar bone those exceed 50% of the expected implant length; guided bone regeneration with rigid mesh or maxillary sinus floor elevation or cortical autologous bone tenting is preferred for bone increments with staged implant implantation. This consensus will provide clinical physicians with appropriate augmentation strategies for alveolar bone defects.

The question about the numerical value and quantitative data transfer of implant prosthodontics-orom experience guidance to digital guidance / 华西口腔医学杂志

The correct implant site design and placement are the basic clinical techniques that must be known for implant restoration. For a long time, most implants have been placed by free hands, and the choice of site is mostly dependent on the accumulation of long-term experience of the surgeon. The selection of implant site guided by this experience analogy logic is often based on the surgeon's level of experience,which often makes it very easy to produce complications related to the implant restoration of the incorrect site. In contrast, a clinical program using digital guidance and real-time measurable verification has emerged based on the restoration-oriented implantation concept, which marks the formation of an accurate, measurable and verifiable whole-process digital implant prototype. Furthermore, from the perspective of surveying, the numerical requirements that digital implant restoration relies on are actually incomplete to the four elements of measurement, which leading to the doubts about its authenticity. This article will question the numbers in implant restoration, and conduct a preliminary demonstration, and propose a new reliable actual measurement and verification method of the correct location and the numerical requirements of the restoration space and a new clinical program that relies on numbers from the perspective of the evolution of digital restoration, guided implantology and actual measurement technology. And this article further discusses the current mainstream implant restoration technology based on experience analogy which cannot effectively support the whole process of digital implant restoration and provides a new logical cognitive basis for the final realization of the entire process of digital implant restoration.

Interarch distance is a target restorative space value: clinical decisionmaking of implant restoration guided by measured value / 华西口腔医学杂志

When design an implant restoration for edentulous patients, many doctors ignore the sufficiency of the interarch distance (vertical distance) or horizontal distance of the patient to accommodate the superstructure and restoration before designing the implant plan. However, the connotation of measuring the interarch distance or horizontal distance has not been clarified in clinical practice. It is often based on visual estimation after operation, and the decision-making path of implant restoration is inverted, resulting in many mistakes regarding the restoration after implantation. The main reason is the lack of standardized paths and practical methods to use before surgery. This article recommended initially establishing a maxillo-mandibular relationship based on natural teeth, old dentures, or new ones and then using the height and horizontal distance or angle of the target restorative space, which was easier to grasp as the measured index. The minimum vertical distance (including the height of the gingival surface and the bone surface) and the horizontal distance (or the angle from the bone or gingival surface to the proposed occlusal plane) should be measured before operation. A decision tree of edentulous jaw restoration guided by the values of the repair space was established based on the measured values. This article clarified the measuring points and planes and thus provided a quantitative relationship basis for the design of implant restoration.

Digital workflow of immediate implant-supported restoration for atrophic edentulous patients / 口腔疾病防治

@#Rehabilitation and reconstruction of atrophic edentulous predicament represents significant challenges for implant dentists due to the anatomical conditions of the edentulous jaw. Implant-supported fixed complete dental prostheses represent a scientifically and clinically validated treatment for recovering patients, masticatory function and esthetic effect. However, the highly demanding implant surgical techniques and complex rehabilitation procedures for immediate functional reconstruction make it difficult to achieve the desired treatment outcomes. The application of digital and CAD/CAM technology in various stages of the treatment process is logical for patients and dentists. This article summarizes the workflow of digital-assisted implantation with immediate functional reconstruction of atrophic edentulous combined with a clinical case. Digital-assisted diagnosis, design, implantation, immediate reconstruction and final rehabilitation can optimize the implant surgery and immediate rehabilitation workflow, improve the accuracy of implant-supported immediate functional reconstruction, reduce the demand for a large amount of bone graft, and achieve higher patient satisfaction. The “prosthetic-oriented, begin with the end in mind” concept of edentulous jaw implant prosthetics can accurately and efficiently restore the patient,s beauty and chewing function in a minimally invasive manner, and is worthy of clinical promotion.

Cicatrizadores personalizados: relato de caso / Customized healing abutments: case report

Quando feita a instalação de um implante imediato pode se optar entre a instalação de uma coroa provisória clínica, um cicatrizador ou pode se optar pelo fechamento do implante para um tratamento em duas etapas cirúrgicas. O uso de cicatrizadores personalizados sela os implantes e leva a uma cicatrização individualizada, que favorece a confecção das coroas subsequentes. O presente trabalho objetiva relatar um caso clínico envolvendo um implante imediato e a instalação de um cicatrizador personalizado, demonstrando os resultados e a importância de conhecimento dessa técnica pelo cirurgião-dentista.

When installing an immediate implant, you can choose between installing a temporary clinical crown, healing abutments, or to close the implant for a two-step surgical treatment. The use of customized healing abutments seals the implants and leads to individualized healing, which favors the creation of subsequent crowns. The present study aims to report a clinical case involving an immediate implant and the installation of customized healing abutments, demonstrating the results and the importance of knowledge of this technique by the dentist.

A study of the esthetic outcomes of peri-implant soft tissue conditioning with provisional restorations and healing abutments / 口腔疾病防治

Implant restoration ; Provisional restoration ; Healing abutment ; Esthetic zone ; Esthetic outcomes@#To compare the esthetic outcomes of peri-implant soft tissue conditioning with provisional restorations and healing abutments.@*Methods @#A total of 48 patients missing a single tooth in the esthetic zone were chosen for the present study and divided into two groups. Twenty-six patients in Group A used provisional restorations to condition the peri-implant soft tissue before final restorations, while 22 patients in Group B used healing abutments to condition the soft tissue. All patients were evaluated by pink esthetic scores (PESs) at the time of the final restoration and at a 1-year follow-up. @*Results@#A total of 26 implants in Group A and 22 implants in Group B showed good peri-implant soft tissue condition. PESs at the time of the final restoration and at the 1-year follow-up in Group A were 8.18 and 8.35, respectively, and 6.73 and 8.18 in Group B, respectively. PESs at the time of final restoration and at the 1-year follow-up were not significantly different in Group A but were significantly different in Group B. The PESs of the two groups were significantly different at the final restoration but were not significantly different at the 1-year follow-up. @*Conclusions @#Provisional restoration in the esthetic zone can improve the pink esthetic effect when permanent restoration.

Application of All-on-Four technology in the field of dental implants / 口腔疾病防治

@#Dental implant restoration is an effective way to restore the chewing and aesthetic function for edentulous. However, dental implant restoration is facing great challenges of the lack of available bone, the maxillary sinus or inferior alveolar nerve vascular bundle, which is often necessary to carry out the related bone augmentation operation. All-on-Four technique is to use four implants in the anterior part of complete edentulous jaws, the two most anterior implants are placed axially whereas the two posterior implants are placed distally angled, to support a provisional, fixed, and immediately loaded prosthesis. The technique avoids the artificial bone substitutes implantation and maxillary sinus augmentation or other bone augmentation surgery. Besides, it could alleviate patients' psychological reaction, postoperative reaction, as well as time and money costs. It is considered a feasible treatment method to combine the application of the oblique implant and the axial implant in the treatment of the edentulous patients. This paper will elaborate on the concept of All-on-Four, the conventional technology, the evaluation research and some new viewpoints.

The short-term efficacy of implant in the treatment of patients with dentition defect caused by chronic periodontitis / 口腔疾病防治

Objective @#To investigate the short-term efficacy of implant in the treatment of patients with dentition defect caused by chronic periodontitis. @*Methods @#53 patients with mild to moderate chronic periodontitis treated in our hospital from June 2014 to May 2015 were selected as observation group, and 53 patients without periodontal diseases in the same period were selected as control group. The plaque index (PLI), sulcus bleeding index (SBI), periodontal probing depth (PD) and gingival papilla index (PIS) were measured at six months and one year after operation, respectively. Interleukin-6 (IL-6), interleukin-8 (IL-8), high sensitive C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α) were detected at six months and one year after operation, respectively. At the last follow-up, the survival rate of two groups were calculated.@*Results @#One year after operation, 5 of the 64 implants in the observation group failed compared with 2 of the 71 implants in the control group. There was no statistical difference in the implant survival rate between the two groups (92.19% vs 97.18%, P=0.191). There was no significant difference in SBI (t=0.936, P=0.351)、 PLI (t=0.457, P=0.649)、PIS (t=1.132, P=0.217)、PD (t=0.957, P=0.341) between the two groups at six months after operation. One year after operation, the periodontal index of the observation group was higher than that of the control group SBI (t=5.297, P=0.000)、 PLI (t=2.341, P=0.021)、 PIS (t=8.218, P=0.000) and PD (t=6.492, P=0.000). The levels of IL-6 (t=6.463, P=0.000)、 IL-8 (t=7.202, P=0.000)、 hs-CRP (t=4.237, P=0.000) and TNF-α (t=6.194, P=0.000) in the observation group were higher than those in the control group at six months after operation. One year after operation, the level of inflammatory factors in the observation group was higher than that in the control group IL-6 (t=12.835, P=0.000)、 IL-8 (t=13.207, P=0.000)、 hs-CRP (t=11.319, P=0.000) and TNF-α (t=8.117, P=0.000). @*Conclusion @# Implant as the treatment of patients with dentition defect caused by chronic periodontitis obtained satisfied short-term effect, but its long-term efficacy remains to be further verified.

Influence of Chronic Periodontitis on the Clinic Effect of Implant Restoration / 现代生物医学进展

Objective:To investigate the influence of chronic periodontitis on the clinic effect of implant restoration.Methods:Fifty-two cases of chronic periodontitis patients with 70 implants and forty-nine cases of periodontally healthy patients with 69 implants admitted into our hospital from July 2013 to June 2016 were named as observation group and control group respectively.The implants survival rates,marginal bone loss (MBL),modified plaque index (mPLI),modified sulcus bleeding index (mSBI),and peri-implant probing pocket depth (PD) as well as IL-1,IL-6 in peri-implant sulcular fluid of the two groups were detected and analyzed after loading of 1,3,6,12 months.Results:After 12 months of loading,no obvious difference was found in the implants survival rate between two groups (P＞0.05).After 1,3 months of loading,no remarkable change was found in mPLI,mSBI,PD,and MBL between two groups(P＞0.05),while mSBI,PD,and MBL in observation group were significantly higher than those of control group except of mPLI after 6 months of loading (P＜0.05).Additionally,after 1,3 months of loading,IL-β in control group was not detected,while IL-β in observation group was conspicuously higher than those of control group after 6 months of loading and IL-6 in observation group was significantly higher than that of control group after 3 months of loading (P＜0.05).Conclusion:Chronic periodontitis could decrease the clinical effect ofim-plant restoration,which was probably due to the occurrence ofperi-implantitis.

The prognosis of splinted restoration of the most-distal implants in the posterior region

PURPOSE: The aim of this study was to compare the efficacies of two-implant splinting (2-IS) and single-implant restoration (1-IR) in the first and second molar regions over a mean functional loading period (FLP) of 40 months, and to propose the appropriate clinical considerations for the splinting technique. MATERIALS AND METHODS: The following clinical factors were examined in the 1-IR and 2-IS groups based on the total hospital records of the patients: sex, mean age, implant location, FLP, bone grafting, clinical crown-implant ratio, crown height space, and horizontal distance. The mechanical complications [i.e., screw loosening (SL), screw fracture, crown fracture, and repeated SL] and biological complications [i.e., peri-implant mucositis (PM) and peri-implantitis (PI)] were also evaluated for each patient. In analysis of two groups, the chi-square test and Student's t-test were used to identify the relationship between clinical factors and complication rates. The optimal cutoff value for the FLP based on complications was evaluated using receiver operating characteristics analysis. RESULTS: In total, 234 patients with 408 implants that had been placed during 2005 - 2014 were investigated. The incident rates of SL (P<.001), PM (P=.002), and PI (P=.046) differed significantly between the 1-IR and 2-IS groups. The FLP was the only meaningful clinical factor for mechanical and biological complication rates in 2-IS. CONCLUSION: The mechanical complication rates were lower for 2-IS than for 1-IR, while the biological complication rates were higher for 2-IS. FLP of 39.80 and 46.57 months were the reference follow-up periods for preventing biological and mechanical complications, respectively.

Relationship of tooth mortality and implant treatment in Type 2 diabetes mellitus patients in Korean adults

PURPOSE: The purpose of this study was to to analyze the effect of Type 2 diabetes on tooth mortality, implant treatment and prosthetic status. MATERIALS AND METHODS: 275 Type 2 diabetics and 300 non-diabetics, aged 40-80 years were selected for analysis. The assessment of number of teeth, missing teeth, fixed prostheses (bridge pontics), implants using panoramic radiographs and dental records were carried out. RESULTS: Diabetes mellitus (DM) patients had a higher number of missing teeth (P<.05) and placed implants (P=.074), age (P<.05), male gender percentage (P=.042), smoker percentage (P<.05) than non-DM patients. In univariate analysis, the patients in older group showed significantly higher number of tooth loss rate at the first dental examination than the patients in younger group. Tooth loss rate of smokers did not show higher value than that of non-smokers. When multiple variables including DM, age, smoking, gender were considered together, diabetics and older group patients showed significantly higher tooth loss rate at the first dental examination than non-diabetics and younger group patients, respectively. Smokers and male group did not show a significant difference than non-smokers and female group, respectively. CONCLUSION: Tooth mortality and implant treatment rate were significantly higher in the DM group as indicated by univariate and multivariate logistic regression analysis. Old age groups showed significantly higher odds ratios and tooth loss rate. As diabetics showed the higher tooth loss rate than non-diabetics, diabetics also had more implant restorations than non-diabetics.

The influence of hyperthyroidism on implant restoration treatment outcome.

There is limited information about bone implant restoration treatment on edentulous patient with hyperthyroidism. This clinical report is presenting the making of dental bone implant restoration on patient with hyperthyroidism history. A 60 years old male patient with hyperthyroidism came to Prosthodontic Clinic Faculty of Dentistry University of Indonesia to improve his ailing denture. After comprehensive evaluation we treated the patient with Implant-Tissue-Supported Overdenture (4 Implants) for rehabilitating upper edentulous jaw, and 2 Implant-Tooth-Supported Fixed Partial Denturesfor rehabilitating Kennedy class II lower edentulous jaw respectively. Short term clinical and radiographic evaluation based on Buser’s criteria showed positive result.

Mini ongoing implant to replace anterior single missing tooth with limited space: A clinical report / 대한치과보철학회지

For a missing teeth, orthodontic treatment may be a better choice of treatment in comparison to a conventional prosthetic replacement such as FPD, resin bonded prosthesis in view of aesthetics, periodontal health and function. Occasionally after an orthodontic treatment, an insufficient space may occur. The mini-implant could be an alternative in situations of narrow ridge dimension, where conventional root form implant could be compromised. The aim of this clinical report is to describe how a space that could not be restored with a traditional root form endosteal implant was managed and to present a technique to achieve optimal anterior esthetics in single implant restoration.