ABSTRACT
Background: There is a need for long-term evidence of immediate function dental implants inserted in grafted bone. The aim of this retrospective study was to investigate the outcome of full-arch rehabilitations supported by implants in grafted bone. Methods: Thirty-six patients (women: 24; men: 12; average age: 53.5 years) were included (225 implants). Primary outcome measure: to assess implant cumulative success rates evaluated through life tables. Secondary outcome measures: to evaluate implant and prosthetic survival, marginal bone loss, and the incidence of both biological and mechanical complications. Results: Twenty-five implants were unsuccessful giving a dental implant CS rate of 88.1% at 14 years and a 76.8% survival estimation (Kaplan−Meier) using the patient as the unit of analysis. No prosthesis was lost. Average MBL at 10 years was 2.01 mm. The incidence of biological complications was 36%, with smoking affecting it significantly (p < 0.001). The incidence of mechanical complications was 86.1% (45.2% and 54.8% in provisional and definitive prosthesis, respectively. Conclusions: The rehabilitation of atrophic maxillae through dental implants in immediate function inserted in grafted bone is a valid treatment alternative, despite the relevant rate of implant failures and incidence of complications.
ABSTRACT
BACKGROUND: Risk factors for medication-related osteonecrosis of the jaw (MRONJ) are well known, although few studies evaluate the factors that influence treatment outcomes in MRONJ and whether discontinuing antiresorptive medication influences healing. PURPOSE: (1) Describe the characteristics of a population of patients with MRONJ. (2) Identify the factors associated with favourable outcomes. (3) Identify a temporal correlation between discontinuation of antiresorptives and healing time. METHODS: A retrospective longitudinal cohort study was carried out, including 77 patients with MRONJ treated between 2004 and 2016. Primary outcome was defined as healed/improved vs. worse/stable. Time to healing was set as the secondary outcome. Statistical significance was defined as p < 0.05. RESULTS: Primary disease, route of administration, lesion location, and development of complications influenced the outcome of treatment. Significant differences in outcomes according to primary disease (p < 0.05) were found when staging, gender, and lesion location were held constant. Time to healing was longer for patients who discontinued medication more than 3 months after diagnosis than for those who discontinued at diagnosis or before - respectively, 36, 9, and 7 months (p = 0.01). CONCLUSIONS: The outcome of MRONJ treatment may be influenced by primary disease and route of administration of antiresorptives. Antiresorptive medication discontinuation contributes to reduce healing time in MRONJ.
