Systemic risk factors for peri-implant bone loss: a systematic review and meta-analysis.

The aim of this study was to determine the influence of patient-related systemic risk factors (systemic disease, genetic traits, chronic drug or alcohol consumption, and smoking status) on peri-implant bone loss at least 1 year after implant installation and prosthetic loading. An electronic search was performed of MEDLINE, EMBASE, and The Cochrane Central Register of Controlled Trials up to January 2012. One thousand seven hundred and sixty-three studies were identified. After applying a three-stage screening process, 17 articles were included in the qualitative analysis, but only 13 in the quantitative analysis, since smoking was a common exposure. The meta-analysis of these 13 studies (478 smokers and 1207 non-smokers) revealed a high level of heterogeneity and that smoking increases the annual rate of bone loss by 0.164 mm/year. Exposure to smoking had a harmful effect on peri-implant bone loss. However, the level of evidence for oral implant therapy in patients with systemic conditions is very low. Future studies should be improved in order to provide more robust data for clinical application.

A novel technique to close large perforation of sinus membrane.

Maxillary sinus floor elevation is generally accepted as a regenerative procedure to facilitate dental implants placement in the posterior atrophic maxilla. Although the sinus lift procedure is relatively safe, some potential problems could be occur. The most prevalent intraoperative complication is perforation of sinus membrane, which can lead to graft infection and early failure. THE AIM OF THIS WORK: Is to present a new technique to repair large perforation of sinus membrane. THIS CASE REPORT: Is focused on a 10 mm perforation of sinus membrane occurred during preparation of the sinus window. The obliteration of the perforation was obtained by means of suturing sinus membrane with a resorbable material to the bone directly lateral to the osteotomy site. Sinus augmentation procedure could complete and the insertion of a graft was permitted.

Immediate versus delayed positioning of dental implants in guided bone regeneration or onlay graft regenerated areas: a systematic review.

The aim of this study was to compare success rates in immediate and delayed dental implant placement following guided bone regeneration or onlay bone block ridge augmentation. A systematic review of all studies on this topic was performed. For inclusion, studies had to involve at least five patients, report specific success criteria, and have a minimum follow-up period of 6 months. Studies reporting only the survival rate of implants were excluded. From 287 studies identified, 79 were screened and 13 were included in the analysis. Six studies provided data on simultaneous (immediate) positioning of implants, five studies on delayed positioning, and two studies provided data on both of these approaches. Success rates for implants placed using a simultaneous approach ranged from 61.5% to 100%; success rates for implants placed using a staged approach ranged from 75% to 98%. Even though the current review revealed that there are not many studies reporting data relevant to the analyzed topic, the data obtained suggest that the delayed positioning of implants should be considered more predictable than the immediate positioning. Studies presenting a control group and adopting standardized success criteria are required, and data from this review must be considered indicative.

Success rate of dental implants inserted in horizontal and vertical guided bone regenerated areas: a systematic review.

This study assessed the success rate of implants placed in horizontal and vertical guided bone regenerated areas. A systematic review was carried out of all prospective and retrospective studies, involving at least five consecutively treated patients, that analysed the success rate of implants placed simultaneously or as second surgery following ridge augmentation by means of a guided bone regeneration (GBR) technique. Studies reporting only the survival rate of implants and studies with a post-loading follow up less than 6 months were excluded. From 323 potentially relevant studies, 32 full text publications were screened and 8 were identified as fulfilling the inclusion criteria. The success rate of implants placed in GBR augmented ridges ranged from 61.5% to 100%; all studies, apart from three, reported a success rate higher than 90% (range 90-100%). The data obtained demonstrated that GBR is a predictable technique that allows the placement of implants in atrophic areas. Despite that, studies with well-defined implant success criteria after a longer follow-up are required.

Endoscopic removal of supernumerary tooth from the nasal cavity of a child: a case report.

INTRODUCTION: A case report showing the removal of a supernumerary tooth from the nasal cavity by means of an endoscopic approach is presented. MATERIALS AND METHODS: A 9-year-old healthy child presented to our department because of the right central incisor which appeared clinically rotated. The observation of orthopantomography revealed the presence of a supernumerary tooth in the anterior maxilla with the crown positioned towards the nasal floor. The maxillary CT demonstrated a quite close relationship of the tooth with the nasal cavity, so a nasal approach was planned. RESULTS: Under general anesthesia the supernumerary tooth was removed by means of an endoscopic approach from a nostril. During the extraction the adjacent structures were unharmed. The postoperative course was uneventful. CONCLUSIONS: This case report suggests that in case of supernumerary teeth positioned close to the nasal cavity, trans-nasal endoscopy may represent a valid alternative to more demolishing traditional surgery.

Four impacted fourth molars in a young patient: a case report.

The occurrence of supernumerary teeth is a relatively uncommon dental anomaly and it's rare for patients to have impacted fourth molars in all quadrant. Aim of this work is to describe the presence of bilateral fourth molars in the maxilla and the mandible in a young male patient aged 22 years came to our hospital with acute pericoronal infection around unerupted third inferior molars. Routine radiographic examination revealed impacted inferior third molars but also unerupted bilateral upper and inferior fourth molars. The acute infection was treated by local measures and the patient was subsequently admitted for removal of third and fourth impacted upper and lower molars under general anesthesia.

Success rate of dental implants inserted in autologous bone graft regenerated areas: a systematic review.

BACKGROUND AND AIM: To assess the success rate of implants placed in atrophic ridges, regenerated by means of block bone grafts harvested from iliac crest, calvaria or intraoral donor sites (mandibular ramus, chin). METHODS AND MATERIALS: A systematic review of all prospective and retrospective studies analyzing the success rate of implants placed simultaneously or as a second surgery following ridge augmentation by means of onlay graft technique, compared with implants placed in pristine bone, was performed. To be included, studies had to involve at least five consecutively treated patients and to report clearly specified success criteria. It was also necessary a minimum follow-up period of six months, to allow the observation of potential biological complications during function, rather than early implant failures. In order to assess the success rate of implants in terms of health of periimplant tissues, implant stability, osteointegration and bone resorption, studies reporting only the survival rate of implants, were excluded. RESULTS: From 323 potentially relevant studies, 65 full-text publications were screened and eight were identified as fulfilling the inclusion criteria. The success rate of implants placed in onlay graft regenerated ridges ranged from 72,8% to 97% after follow-up periods ranging from 6 months to 10 years, with all the studies but two, reporting a success rate higher than 84% (range 84-97%). CONCLUSION: The obtained data demonstrated that the success rate of implants placed in regenerated areas are very similar to those obtained in case of implants placed in pristine bone, and suggested that onlay graft augmentation is a quite predictable technique to allow the placement of implants in severely atrophic areas. Despite that, the current review revealed that there are not many studies providing data on the success rate of dental implants placed in onlay graft augmented ridges and demonstrated, on average, a poor methodological quality. So randomized controlled studies adopting standardized criteria to define success and failure of implants are required and data from this review must be considered indicative.

Prevalence of apical periodontitis and quality of endodontic treatment in an Italian adult population.

OBJECTIVE: The aim of this study was to analyze the prevalence of AP in relation to the quality of endodontic treatment in an Italian adult population. METHODS: We examined panoramic radiographs (OPG) of 384 patients aged between 18 and 60 years who came under observation for a first dental examination. Two experienced examiners assessed the radiographs according to standardized criteria by examining the following parameters: periapical status, quality of endodontic treatment, quality of root canal filling and quality of coronal restoration. RESULTS: 9423 teeth were analyzed. By examining the radiographs 1076 teeth had undergone previous endodontic treatment, of these 448 (41.6%) had AP. Statistical analysis shows a significant association between periapical status and quality of endodontic treatment (p <0.001), between periapical status and quality of root canal filling (p <0.001) and between periapical status and quality of coronal restoration (p <0.001). CONCLUSIONS: The prevalence of AP was found to be closely related to the quality of endodontic treatment, quality of root canal filling and coronal restoration.

Surgical treatment of severe athropic maxilla by means of multiple extraoral harvesting.

AIM.: The aim of the present clinical study is to evaluate the efficacy of autologous bone multiple harvesting in the surgery of the severe atrophic maxilla, in term of quantity and quality of the grafts for the following implant-supported prosthesis treatment. MATHERIAL AND METHOD.: For 5 patients a combined on-lay bone grafting and bilateral sinus lift elevation procedure was performed under general anesthesia. Harvesting site was anterior iliac crest and calvaria. Clinical and radiographic (Rx-OPT and CT Dentascan) examinations were performed to evaluate the bone defects and to programme surgical treatment and during the follow up. RESULTS.: Postoperative complications' evaluation showed no significative problems. Radiographic controls at 4 months showed a minimum or no resorption of calvaria harvesting. CONCLUSION.: In the reconstruction of the severe atrophies of the alveolar edentoulus crests, a multiple extra-oral harvesting seems to improve quality and quantity of bone graft, so that the following implant-supported prosthesis treatment is facilitated.