Biological implant complications and their management.

BACKGROUND: Background: With the increasing popularity of dental implants the presence of implant complications is rising, and the question of how to best manage these complications still lingers in most clinicians' minds. This paper aims to provide clinicians with an overview of the most commonly encountered biologic implant complications as well as to provide guidelines as to how to treat them. METHODS: Available English literature was reviewed, including peer-reviewed journal publications and online resources. Several treatment modalities have been proposed to manage these complications, including non-surgical mechanical debridement, antiseptics, local and/or systemic antibiotics, lasers, resection with or without implantoplasty and regenerative approaches. RESULTS: In this guideline, it is suggested that the treatment modalities should be chosen based on the severity of peri-implant diseases, amount of bone loss and the morphology of peri-implant bony defects. For peri-implant mucositis or peri-implant defects with less than 2 mm destruction, non-surgical treatments are recommended. For peri-implant defects with more than 2 mm destruction, surgical treatments (e.g., resection with or without implantoplasty, guided bone regeneration) are suggested that include removal of the implant if the bone loss is beyond repair. CONCLUSION: The prevention of biological implant complications relies on careful planning, a thorough examination to assess etiological factors and a regular maintenance recall schedule. With early diagnosis, biological implant complications should be managed based on the severity of peri-implant disease, the amount of bone loss and the morphology of the peri-implant bony defects.

Surgical crown lengthening in a population with human immunodeficiency virus: a retrospective analysis).

BACKGROUND: Individuals with human immunodeficiency virus (HIV) have an increased risk of developing health problems, including some that are life threatening. Today, dental treatment for the population with a positive HIV diagnosis (HIV+) is comprehensive. There are limited reports on the outcomes of intraoral surgical therapy in patients with HIV, such as crown lengthening surgery (CLS) with osseous recontouring. This report investigates the outcome of CLS procedures performed at an urban dental school in a population of individuals with HIV. Specifically, this retrospective clinical analysis evaluates the healing response after CLS. METHODS: Paper and electronic records were examined from the year 2000 to the present. Twenty-one individuals with HIV and immunosuppression, ranging from insignificant to severe, underwent CLS. Pertinent details, including laboratory values, medications, smoking history/status, and postoperative outcomes, were recorded. One such surgery is described in detail with radiographs, photographs, and a videoclip. RESULTS: Of the 21 patients with HIV examined after CLS, none had postoperative complications, such as delayed healing, infection, or prolonged bleeding. Variations in viral load (<48 to 40,000 copies/mL), CD4 cell count (126 to 1,260 cells/mm(3)), smoking (6 of 21 patients), platelets (130,000 to 369,000 cells/mm(3)), and neutrophils (1.1 to 4.5 × 103 /mm(3)) did not impact surgical healing. In addition, variations in medication regimens (highly active anti-retroviral therapy [18]; on protease inhibitors [1]; no medications [2]) did not have an impact. CONCLUSIONS: The results of this retrospective analysis show the absence of postoperative complications after CLS in this population with HIV. Additional investigation into this area will help health care practitioners increase the range of surgical services provided to this group of patients.