Clinical efficacy of antibiotics in the treatment of peri-implantitis.

OBJECTIVES: The aim of the present study was to review the pertinent literature with reference to the clinical efficacy of antibiotics in the treatment of peri-implantitis. METHODS: To address the focused question 'Are locally and systemically delivered antibiotics useful in the treatment of peri-implantitis?' PubMed/Medline and Google-scholar databases were explored from 1992 until February 2013 using a combination of the following keywords: 'antibiotic,' 'dental implant,' 'inflammation,', 'peri-implantitis' and 'treatment'. Letters to the editor, case-reports and unpublished data were excluded. RESULTS: Ten studies were included. In six studies, peri-implantitis was treated using a non-surgical approach (scaling and root planing), whereas in four studies, a surgical approach was adopted for treating peri-implantitis. In three studies systemic antibiotics were administered and in six studies locally delivered antibiotics were used for treatment. One study used the oral route for antibiotic delivery. In three studies, minocycline hydrochloride was locally delivered as an adjunctive therapy to non-surgical mechanical debridement of infected sites. Nine studies reported that traditional peri-implantitis treatment with adjunct antibiotic therapy reduces gingival bleeding, suppuration and peri-implant pocket depth. In one study, despite surgical debridement of infected sites and systemic antibiotic cover, nearly 40% of the implants failed to regain stability. There was no placebo or control group in eight out of the nine studies included. CONCLUSION: The significance of adjunctive antibiotic therapy in the treatment of peri-implantitis remains debatable.

Pain sensation and postsurgical complications in posterior mandibular implant placement using ridge mapping, panoramic radiography, and infiltration anesthesia.

Objectives. The aim of this study was to investigate intrasurgical and after surgical, pain and the incidence of after surgical alteration of sensation in the mandible and lower lip when placing implants in the posterior mandible using ridge mapping, panoramic radiography, and infiltration anesthesia. Methods. This was a longitudinal clinical study of healthy patients needing implant placement in the posterior mandible. After thorough examination and treatment plan using ridge mapping and panoramic radiography, all patients received dental implants under local infiltration anesthesia. The patients were then given a questionnaire to assess the pain during anesthesia and implant surgery. Change of sensation in the lower lip was evaluated by standard neurosensory examination tests at 7 days and 1 and 4 months. Prosthetic treatment was carried out 4 months postsurgery and the patients were followed for an average of 28.5 months afterwards. Results. A total of 103 implants were placed in 62 patients. Patients reported very minor pain during injection. No pain was reported during either implant placement or bone grafting procedures. No alteration of sensation in the mandible or lower lip was recorded postsurgery. Conclusion. In most cases, ridge mapping, panoramic radiography, and infiltration anesthesia are sufficient for posterior mandibular implant placement without pain or complications.

Dental clinics as potent sources for screening undiagnosed diabetes and prediabetes.

INTRODUCTION: This pilot study investigated the efficacy of dental clinics as potent sources for screening diabetes and prediabetes in undiagnosed individuals. METHODS: Data were randomly collected from 385 patients (aged 40 years and older) visiting dental clinics. Patients already having a diagnosis of diabetes and/or prediabetes were excluded. Demographic data, body mass index and family and dental histories were recorded. Signs and symptoms of diabetes were investigated. Random blood glucose levels (RBGLs) were recorded. Individuals with RBGL ≥110 mg/dL underwent the oral glucose tolerance test and the glycosylated hemoglobin test (HbA1c). RESULTS: Of the 385 patients, 60% (232) had RBGL <110 mg/dL, whereas 40% (153) had RBGL ≥110 mg/dL. Prevalence of confirmed diabetes and prediabetes among the study participants was 16.4% and 15.8%, respectively. Body mass index was significantly higher among patients with diabetes and prediabetes as compared with healthy controls. HbA1c level was statistically significantly higher among patients with diabetes than among patients with prediabetes. Symptoms of polyuria and polydipsia were significantly higher among patients with diabetes than in those without diabetes. CONCLUSIONS: A high percentage of undiagnosed type 2 diabetes and prediabetes among patients visiting dental clinics was found compared with that reported in the medical literature. Further studies with a lager sample size are needed to confirm these results.

Osteotome maxillary sinus lift using bovine bone and calcium sulfate: a case series.

PURPOSE: The purpose of this longitudinal study was to evaluate the success of bovine bone and calcium sulfate (CaSO(4)) as sinus augmentation material with osteotome maxillary sinus lift. MATERIALS AND METHODS: Thirty-one osteotome sinus lift procedures were performed for 18 healthy patients (7 males and 11 females). A mixture of bovine bone and CaSO(4) (ratio, 4:1) was used as sinus augmentation material with simultaneous implant placement. Implants were loaded 4 to 5 months postimplant surgery. Cases were followed for an average of 23.4 months postloading (range, 12-60 months). RESULTS: The mean age of the study group was 49.7 ± 10.66 years. The residual height of the alveolar ridge ranged from 5.5 to 11 mm (mean, 8.16 ± 1.52 mm). Four to 5 months after implant placement, the x-ray showed a 1.5 to 5 mm apical shift of the sinus floor (mean, 3.47 ± 0.97 mm), which was maintained to the end of the evaluation period. At 12 months postloading, crestal bone loss ranged from 0.5 to 1.5 mm (mean, 0.87 ± 0.26 mm), and pocket depth ranged from 2 to 4 mm (mean, 2.9 ± 0.67 mm). No significant change in crestal bone loss or pocket depth was noticed afterward. CONCLUSION: Bovine bone plus CaSO(4) can be used successfully as a sinus augmentation material with osteotome sinus elevation. The use of CaSO(4) significantly improved the handling properties of bovine bone and helped to stabilize the bone graft particles during healing.

Successful treatment of early implant failure: a case series.

BACKGROUND: The aim of this longitudinal study was to evaluate the effect of combined treatment on early progressive bone loss around dental implants. METHODS: The study sample consisted of 18 implants presenting at 4-6 weeks postplacement with early progressive bone loss. Clinical examination indicated the presence of a fistula in the soft tissue covering the implants in most cases. Defects around the implants were curetted, exposed implant surfaces were mechanically debrided and treated with tetracycline solution, and the defects were filled with bone graft and doxycycline powder. Bioabsorbable membranes were used. Final crowns were placed after 6 months. The patients were followed for an average of 30 months. RESULTS: The surgical sites healed without complication. At the time of loading, the defects were completely restored. At 12 months postloading, there was crestal bone loss to the level of the first thread (average, 1.3 mm). Pocket depths ranged from 3 to 5 mm (average, 3.6 mm) with no bleeding. No further changes were noticed throughout the remaining follow-up visits. All implants were successful according to the criteria proposed by Albrektsson and colleagues. CONCLUSIONS: Early detection and treatment of early progressive bone loss around dental implants are the key to saving early failing implants. The author recommends reevaluation visits 4-6 weeks postimplant placement to detect any signs of early failure so that immediate treatment can be undertaken if needed.

Inferior alveolar nerve injury in implant dentistry: diagnosis, causes, prevention, and management.

Inferior alveolar nerve injury is one of the most serious complications in implant dentistry. This nerve injury can occur during local anesthesia, implant osteotomy, or implant placement. Proper understanding of anatomy, surgical procedures, and implant systems and proper treatment planning is the key to reducing such an unpleasant complication. This review discusses the causes of inferior alveolar nerve injury and its diagnosis, prevention, and management.

Corticotomy facilitated orthodontics: Review of a technique.

Corticotomy found to be effective in accelerating orthodontic treatment. The most important factors in the success of this technique is proper case selection and careful surgical and orthodontic treatment. Corticotomy facilitated orthodontics advocated for comprehensive fixed orthodontic appliances in conjunction with full thickness flaps and labial and lingual corticotomies around teeth to be moved. Bone graft should be applied directly over the bone cuts and the flap sutured in place. Tooth movement should be initiated two weeks after the surgery, and every two weeks thereafter by activation of the orthodontic appliance. Orthodontic treatment time with this technique will be reduced to one-third the time of conventional orthodontics. Alveolar augmentation of labial and lingual cortical plates were used in an effort to enhance and strengthen the periodontium, reasoning that the addition of bone to alveolar housing of the teeth, using modern bone grafting techniques, ensures root coverage as the dental arch expanded. Corticotomy facilitated orthodontics is promising procedure but only few cases were reported in the literature. Controlled clinical and histological studies are needed to understand the biology of tooth movement with this procedure, the effect on teeth and bone, post-retention stability, measuring the volume of mature bone formation, and determining the status of the periodontium and roots after treatment.

Management of combined ridge defect and osteotome sinus floor elevation with simultaneous implant placement--a 36-month follow-up case report.

This report demonstrated the management of combined ridge defect and maxillary sinus pneumatization with simultaneous implant placement. One case with vertical and horizontal ridge deficiency and sinus pneumatization in the maxillary premolar area was indicated for ridge augmentation and sinus elevation before implant placement. Implant osteotomy was enlarged using a ridge expansion osteotome to 1 mm short of the sinus floor; sinus elevation was performed using sinus lift osteotomes; the implant was placed; bone graft and resorbable membrane were used to augment the remaining defect. The second stage was done after 6 months, followed by final restoration. The patient was reevaluated for 36 months following the final prosthesis. The surgical site healed without complication following implant placement. During the second stage, the implant was completely surrounded by bone, with bone covering the buccal aspect of the cover screw. The X-ray showed a 5 mm apical shift of the sinus floor at 6 months post surgery. At 12 months post loading, crestal bone loss to the level of the first thread was noted; no changes were observed at the sinus or surrounding teeth. Pocket depth ranged from 3-4 mm. No further bone loss or soft tissue contour change was noted at 18, 24, 30, and 36 months post loading. The combination of these three techniques with simultaneous implant placement as described in this report seems to be successful. Further research is needed to evaluate whether the combination of these techniques with simultaneous implant placement offers similar results when compared with the stage approach.

Predoctoral dental implant education at King Abdulaziz University.

OBJECTIVE: In June 2008, a survey of freshly graduated dental students of King Abdulaziz University Jeddah was conducted to evaluate the extent of their exposure to oral implantology and their knowledge of some basic principles of dental implant treatment. MATERIALS AND METHODS: Multiple-choice questionnaires were given to the fresh graduate dental students of King Abdulaziz University Jeddah to answer. Sixty-six students responded out of 86, yielding a response rate of 76.7%. RESULTS: Majority of the students (78.8%) thought that they did not have enough lectures about dental implants and all of them thought that they did not have enough training in dental implant. Most of the students were not familiar with different dental implant systems (61.1%), designs (60.6%) or sizes (74.2%). Majority of the students were lacking the knowledge about basic principles of dental implant treatment. At King Abdulaziz University, Faculty of Dentistry, implant dentistry is taught to the students in the form of implant-related lectures incorporated into their periodontic, oral surgery and prosthodontic courses with one or two lectures given on dental implant in each course. CONCLUSION: There is an urgent need to develop a well-structured implant course that includes didactic, laboratory, preclinical and clinical components at the undergraduate curriculum of King Abdulaziz University Faculty of Dentistry.

A new tunnel technique with acellular dermal matrix for soft tissue preparation prior to symphyseal block graft--a description of technique and case report.

The aim of this report was to describe a newly designed tunnel technique (A New Tunnel Technique) using acellular dermal matrix (ADM) allograft for soft tissue augmentation prior to mono-cortical block graft. Two cases with vertical and horizontal ridge deficiency in the mandibular anterior area were indicated for mono-cortical block grafting before implant placement. Soft tissue evaluation and measurements showed thin tissue covering the defect area composed mainly of nonkeratinized alveolar mucosa measuring 1 to 2 mm in most of the sites. Soft tissue augmentation was done first using a new tunnel technique with ADM allograft. After 2 months of healing, mono-cortical block graft was harvested from the mandibular symphysis area and fixed to the recipient site. Soft tissue measurements were made before soft tissue graft and immediately before block graft. Healing was evaluated at 2, 4, 12, and 24 weeks post-block grafting surgery to evaluate healing. In both cases, there was generalized 1- to 2-mm increase in soft tissue thickness covering the defect areas following allograft. Both cases had healed uneventfully with no soft tissue complications following block grafting procedure to the time of implant placement. The new tunnel technique for soft tissue augmentation using acellular dermal matrix allograft seems to be a valid approach in soft tissue preparation prior to mono-cortical block grafting. Further research is needed to evaluate if this procedure will help to prevent soft tissue complications associated with block grafting.