Indications for implant-supported rehabilitation of the posterior atrophic maxilla: A multidisciplinary consensus among experts in the field utilising the modified Delphi method.

PURPOSE: To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction. MATERIALS AND METHODS: A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evalu-ated by all participants. After the forms were completed, the responses were sent for blinded ana-lysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned. RESULTS: After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement. CONCLUSION: This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of bucco-palatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable.

Cone-beam computed tomography assessment of maxillary anterior alveolar bone remodelling in extraction and non-extraction orthodontic cases using stable extra-alveolar reference.

OBJECTIVE: To explore alveolar cortical positional change in response to tooth movement in extraction and non-extraction orthodontic cases, using cone-beam computed tomography (CBCT) and stable extra-alveolar references. MATERIALS AND METHODS: The pre-treatment (T1) and post-treatment (T2) CBCT scans of 25 extraction (EXT) and matched 25 non-extraction (Non-EXT) orthodontic cases were imported into Dolphin Imaging 3D, and oriented uniformly. Sagittal and axial CBCT cross-sections were traced using customized software-generated guides. The displacement of teeth and alveolar bone cortices were automatically measured using the palatal plane (PP) and the line perpendicular to PP and passing Sella as reference. Intra- and inter-group differences between T1 and T2 were analysed. Subjects were also superimposed three-dimensionally using Geomagic Control X for qualitative analysis of cortical remodelling. RESULTS: The EXT group showed incisor retraction, while the Non-EXT group exhibited statistically significant incisor anterior tipping (P < .05). In EXT, both the labial and palatal cortices are resorbed. Non-EXT showed labial cortex anterior modelling, and statistically significant palatal cortex resorption (P < .05). In both groups, statistically significant decrease in total and palatal alveolar widths, increase in labial widths, and palatal dehiscence were observed. Comparatively, EXT showed significantly more incisal total and palatal width decrease and palatal vertical bone loss. CONCLUSION: Labial cortical remodelling was shown to follow anterior tooth movement, but the palatal cortical response to incisor retraction and labial cortical remodelling in general remained inconclusive. Narrowing of the alveolar housing and palatal dehiscence were observed regardless of extraction following orthodontic treatment.

Inferior alveolar nerve topography and its bifurcation features: a cone beam computed tomography evaluation.

BACKGROUND: Mandibular canal (MC) is the most important vital structure in mandible to prevent from complications such as bleeding and paresthesia. The aims of the present study were to inform the features (diameter, distances to the mandibular borders, and distance to tooth apex) of the MC for each posterior tooth region, and to present the bifurcation features of the MC. METHODS: Four-hundreds-eighteen MC images of 209 patients were evaluated. The parameters were recorded from right and left hemi-mandibles for each posterior teeth region: 1) MC diameter; 2) MC and mandibular basis distance; 3) MC and crest distance; 4) MC and tooth apex distance; 5) MC and buccal plate distance; 6) MC and lingual plate distance; and 7) possible implant length (the distance between 2 mm coronal of the MC and 1 mm apical of the crest). Additionally, MC bifurcation type and bifid mandibular canal length were noted for right and left sides. RESULTS: While higher MC diameter values were recorded at molars, MC diameter in first premolars bilaterally were the lowest. In premolars, MC and mandibular basis distance showed higher values than molars. There was a trend of decrease in MC and crest distance from molars to premolars. The highest MC and tooth apex distance was measured in second molar; however, the lowest was in the first premolar. Additionally, MC and buccal plate distances were higher in molars, while MC and lingual plate distances were higher in premolars. Possible implant length in first premolar was the lowest, when it was the highest in second molars. CONCLUSIONS: For simulating overall MC topography, it extended bucco-coronally from molars to premolars. Due to this topography, possible implant length increased from premolars to molars.

An alternative treatment for hopeless implants: Coronal resection.

Dental implant surgery is a highly reliable therapy with widespread use all over the world. However, various accidental symptoms and complications such as peri-implantitis have been reported, and occasionally necessitate implant removal. This alternative technique was performed to minimize the harmful effect of conventional resective explantation procedures. The present case concerns a 55-year-old woman who had two dental implants in the mandibular incisor regions who apparently developed severe marginal peri-implantitis. Presence of lesion was confirmed by two and three-dimensional radiographic images. Explantation was indicated because of the excessive ongoing bone loss around implants. Due to avoid serious complications such as jaw fracture, coronal resection technique (partial explantation) was suggested. After the full thickness flap was elevated, affected part of both implants were resected, and osseointegrated healthy apical parts were left in the basal bone. Wound healing was uneventful at one week follow-up. Proper locater abutments were tightened after 5 months of the partial explantation procedure, and final denture was applied in the oral cavity. The radiologic and clinical examinations showed successful outcome at 12-months follow-up. Minimally resective peri-implantitis therapy may be achieved using this non-traumatic coronal implant resection approach.

Ideal Dose and Injection Site for Gummy Smile Treatment with Botulinum Toxin-A: A Systematic Review and Introduction of a Case Study.

The objective of this article is to review ideal injection point and ideal dose of botulinum toxin-A injections to treat different types of gummy smile, and to present a case treated with the recommended method. An electronic search of literature was carried out by using PubMed, Embase, and Google Scholar. Reference lists of studies were also hand-searched for relevance. According to inclusion and exclusion criteria, five prospective studies with 135 subjects were included in this systematic review. Injection of botulinum toxin-A is a noninvasive and temporary treatment option for gummy smile, and the Yonsei point is a safe and reproducible injection point for treatment by practitioners of all types of gummy smile.

Effects of clinical local factors on thickness and morphology of Schneiderian membrane: A retrospective clinical study.

BACKGROUND: It was informed that the thickness of maxillary sinus membrane may be affected by the local and patient-related factors in the literature. PURPOSE: The aim of this retrospective study is to evaluate factors that may have an influence of the thickness and morphology of the maxillary sinus membrane. MATERIALS AND METHODS: A total of 414 cone beam computed tomography images of 207 patients were evaluated. Radiographic parameters were evaluated at each maxillary premolar and molar tooth regions. Statistical analysis was performed to assess the association between the maxillary sinus mucosa thickness and morphology. The following factors including gender, periodontal bone loss (PBL), bone density, amount of residual alveolar bone at the edentulous space, vitality of the teeth present, and anatomical relationship between the sinus floor and posterior teeth were evaluated. RESULTS: The mean thickness of maxillary sinus membrane ranged between 1.47 to 2.92 mm and was significantly thicker in male subjects (P < .05). Positive correlation was detected between the sinus membrane thickness values in each posterior tooth region (P < .05). Thickening of the membrane was noted in 53% of the scans. The most commonly observed morphological change was flat thickening of the membrane (21%). No correlation was found between the evaluated local factors on the thickness and morphology of the maxillary sinus membrane (P > .05). CONCLUSIONS: Tooth vitality, residual alveolar bone height, and PBL seem to have no effect on the thickness and morphology of the maxillary sinus membrane.

The radiological evaluation of posterior superior alveolar artery topography by using computed tomography.

BACKGROUND: Posterior superior alveolar artery (PSAA) is the most important limiting anatomic structure while lateral approach sinus surgeries. PSAA should be taken into consideration to avoid bleeding during preparation of bony window. PURPOSE: The aim of this article was to inform topography of PSAA and to evaluate measurements of this vital structure. MATERIALS AND METHODS: Three hundred and fifty-four cone-beam computed tomography (CBCT) images of PSAA from 177 patients were evaluated retrospectively. Localization of PSAA, diameter of PSAA, classification of PSAA diameter, distance between PSAA and crest, buccal bone thickness, palatal bone thickness, crest height, and crest width were recorded for each posterior tooth separately. RESULTS: The mean age of 177 patients was 54.05 ± 18.33 years. Although the most frequent localization of PSAA was intraosseous in premolar region, they were below Schneiderian membrane in molars. PSAA diameter was measured frequently less than 1 mm for all posterior teeth. Although palatal bone thickness was higher in premolar region than molars, no statistical relationship was found between tooth region and buccal bone thickness (P > 0.05). The width of residual ridge was measured both wider apically and posteriorly. Positive correlation was observed between buccal bone thickness and PSAA diameter in first molar and premolar regions (P < 0.05). CONCLUSIONS: Detailed evaluation of patients by CBCT provided us the opportunity to draw topography of PSAA and inform about overall measurements of PSAA in all posterior teeth region.

Maxillary Sinus and Surrounding Bone Anatomy With Cone Beam Computed Tomography After Multiple Teeth Loss: A Retrospective Multicenter Clinical Study.

PURPOSE: The aim of this multicenter study was to examine the residual alveolar bone anatomy and sinus mucosa pattern at maxillary sinus regions in multiple teeth loss. MATERIALS AND METHODS: This study was conducted with cone beam computed tomography images of 518 patients (267 females and 251 males) with multiple posterior maxillary teeth loss. Variables associated with sinus membrane (SM), sinus dimensions, ostium, septa, sinus neighborhood, alveolar bone height and ridge width, posterior superior alveolar artery, and adjacent roots were evaluated. RESULTS: No (58.2%) or flat (19.3%) thickening morphology was detected at most of the SMs. Membrane thickening and mucosal-like morphology was more prevalent for male patients (P = 0.005). The mean sinus width was relatively low (3.64 ± 3.33 mm) at the 5-mm level and showed an expected increase toward upper levels. Most of the sinus spaces were dimensionally average (39.5%) or wide (44.7%), and no effect of gender was observed in terms of sinus dimensions (P > 0.05). CONCLUSION: Multiple teeth loss plays a role in creating an imaginary sinus anatomy constituted of a relatively narrow space compared with single-tooth loss cases, from 3.6-mm mean coronal width to 11.3 mm in the apical portion.

Anatomic Variation of Posterior Superior Alveolar Artery: Review of Literature and Case Introduction.

The objective of this article is to review topography of posterior superior alveolar artery (PSAA), and to present a case with visualization of a rare anatomic variation of PSAA. An electronic search was undertaken to identify articles about topography of PSAA in Medline, Embase, and Google Scholar databases, published between January 1977 and December 2017. Two animal studies, 8 cadaver studies, 18 cone-beam computerized tomography (CBCT) studies, and 2 review articles were found. The animal studies, cadaver studies, and review articles were excluded because they were not about topography of PSAA. Only CBCT studies were included in this review. Accurate knowledge of vital structures in the surgical area is critical during surgical procedures. PSAA should be analyzed during planning sinus lifting with lateral approach. In the present case, a detailed evaluation of patient by CBCT provided the opportunity to find out a rare variation of PSAA with multiple vessels.

A Comparison of Esthetic Features of Pre-existing Natural Tooth Versus Post-Implant Restoration in the Esthetic Zone: A Retrospective 12-month Follow-up.

PURPOSE: To correlate the link between natural teeth located in esthetic regions of the arches before extraction with their definitive dental implant restorations, and to propose a new and contemporary esthetic index based on the natural dentition (EIND) preoperatively. MATERIALS AND METHODS: Patients possessing a high smile line with teeth requiring implant replacement therapy in the maxillary anterior region were included. Clinical intraoral photographs and periapical digital radiographs taken before extraction and 10 ± 1.5 months (range: 9 to 12 months) after the delivery of implant-supported permanent restorations were used to make the measurements and evaluations according to the proposed index. Pink esthetic score (PES) parameters were analyzed. Statistical analyses of preimplant and postimplant parameters between tooth sites and implant sites were carried out with a computer software program. RESULTS: The study included 51 patients (35 women, 16 men), with a mean age of 39.6 years, with a total of 83 dental implants placed in the maxillary anterior region. Of these, there were 6 right canines, 22 right lateral incisors, 11 right central incisors, 22 left central incisors, 17 left lateral incisors, and 5 left canines. Of the 83 included implants, 67 were immediately and 16 were delayed placed. Statistical analyses between tooth sites and implant sites showed significant differences in tissue contour (P = .001), texture (P = .001), alveolar deficiency (P = .001), and total PES (P = .007). No statistically significant difference was detected in mesial papilla, distal papilla, tissue margin, tissue biotype, and the amount of keratinized mucosa. Additionally, R2 value presented a higher variance and lower predictable values of peri-implant tissue parameters compared with those of the natural dentition. CONCLUSION: This study analyzed various periodontal and peri-implant soft and hard tissue parameters, and a new index system, EIND, was proposed. This index could be used to collect the esthetic-related parameters for pre-extraction treatment planning and provide valuable information for esthetic risk assessment.

Transplantation of Autogenous Bone Block With an Osseointegrated Implant: Seedling Technique With Twelve-Month Follow-Up.

OBJECTIVE: Loss of teeth frequently results in compound horizontal and vertical alveolar bone defects. An appropriate bone structure is the key for implant placement and bony support of soft tissues. Advanced bone augmentation techniques are required for the reconstruction of these defects. This report will present a new bone block grafting technique with 12-month follow-up. METHOD: The seedling technique was used to augment the alveolar bone 3-dimensionally with autologous bone block and an osseointegrated implant in a 2-stage procedure. Horizontal and vertical bone loss is revealed after cone beam radiographic examination in the right maxillary lateral incisor area. Initially, the implant was placed at the right maxillary tuber area, where the bone was abundant. After 2-months healing phase, the osseointegrated implant was harvested with the surrounding bone and transplanted to the anterior region of maxilla to augment the horizontal and the vertical components of the recipient site. Transplanted implant inserted into autogenous bone block was fixed with mini plate to the adjacent native bone. Prosthetic restoration was applied 4 months after the transplantation. RESULTS: Seven months after the first surgery, treatment of anterior bone deficiency was accomplished. The patient was fully satisfied with the function and the esthetics of the restoration. The radiological and clinical examinations at 1-year follow-up evaluation showed successful outcome of transplanted autogenous bone block without any resorption. CONCLUSION: This clinical report demonstrated that anterior maxillary single-tooth replacement, according to seedling concept of autogenous bone block with osseointegrated implant, is a successful and predictable treatment modality.

Evaluation of Single Tooth Loss to Maxillary Sinus and Surrounding Bone Anatomy With Cone-Beam Computed Tomography: A Multicenter Study.

BACKGROUND: Posterior maxillary tooth loss may complicate the implant treatment due to the alterations in alveolar anatomy and maxillary sinus pneumatization. This study aimed to comprehensively examine the anatomical structure of this region from cone-beam computed tomography (CBCT) images. MATERIALS AND METHODS: The posterior maxilla regions with single tooth loss were analyzed by dividing the variables into 3 subgroups from images of 597 patients chosen from 1160 CBCTs. Variables associated with sinus membrane (SM), sinus dimensions, ostium, septa, sinus neighborhood, alveolar bone height (ABH) and width (RW), posterior superior alveolar artery (PSAA), and adjacent roots were evaluated. RESULTS: The majority of the patients demonstrated 0 to 5 mm membrane thickness. Irregular SM thickening was lower for female patients. While females showed higher number of narrow sinus, males had higher RW than females. Sinus augmentation classification showed negative correlation with ABH, root-tip sinus floor and edentulous site classification. Posterior septa height was correlated with number of septa and ABH. PSAA diameter and location were also correlated between each other. CONCLUSION: The present results define formation of a sinus space with 11 mm coronal and 16 mm apical width after single tooth loss. A flat or semispherical thickening around 4 mm is usual in most cases with 51% possibility of anterior septum existence. A ridge anatomy, around 7.5 mm ABH and 7.2 to 9.3 RW from coronal to apical, complements this anatomy. Further studies are needed to clarify the reasons behind the SM and crestal anatomy variations between genders.

Implant-Site Related and Patient-Based Factors With the Potential to Impact Patients' Satisfaction, Quality of Life Measures and Perceptions Toward Dental Implant Treatment.

OBJECTIVES: The present study aimed at evaluating both the implant site-related and patient-based factors with the potential to affect the extent of patients' satisfaction and also their perceptions regarding dental implant treatment. Potential differences between the esthetic evaluations of dental patients and dental specialists were also considered. MATERIALS AND METHODS: Implant-supported fixed prosthesis (n = 164) in 264 anterior esthetic implant sites were included. Patients' satisfaction, esthetic considerations, and perceptions toward dental implants, were evaluated by both Oral Health Impact Profile-14 (OHIP-14) questionnaire and visual analog scale. Pink Esthetic Score/White Esthetic Score were used for the professional esthetic evaluations of dental specialists. RESULTS: Overall patient satisfaction was high (87.42 ± 11.86). Compared with implant supported single-tooth restorations, patients with implant-supported bridges had lower OHIP scores (P = 0.001) and were relatively less satisfied with particular aspects of dental implant treatment (eg, cleanability, phonetics, surgical discomfort, and pretreatment information). Generally, type of prosthesis, history of soft/hard tissue augmentation, and reason for tooth loss had a clear impact on the extent of patients' satisfaction, esthetic considerations regarding treatment outcome, and their perceptions toward dental implant treatment (P < 0.05). CONCLUSIONS: Fixed implant-supported restorations generally provide with high levels of satisfaction and oral health-related quality of life.

Validation of Therapeutic Anatomy-Oriented Classification in Endosseous Dental Implant Treatment: A Pilot Study.

BACKGROUND: The purpose of the study was to validate a newly proposed therapeutic anatomically based clinical and radiological classification for dental implant treatment. METHODS: Eighty-one patients with at least 1 edentulous jaw segment (EJS) from 2 dental clinics were included in this study. Both clinical and radiological parameters were assessed in aesthetic and nonaesthetic zones. The data were then compared at preoperative, intraoperative, and postoperative (subdivided into early and late stage) study stages. RESULTS: Based on the hard and soft tissue support, EJSs were divided into 3 types. The outcomes were then validated at preoperative, intraoperative, and early postoperative stages. Data were then analyzed using paired sample t test and the Wilcoxon signed ranks test. No statistically significant difference (P > 0.05) was identified between any the measurements. CONCLUSIONS: The proposed therapeutic anatomically based clinical and radiological classification for the dental implant treatment seems to be reproducible, objective, and helpful in planning dental implant treatment. Future studies with a larger sample size are needed to further validate the outcome obtained in this pilot study.

Radiographic Fractal and Clinical Resonance Frequency Analyses of Posterior Mandibular Dental Implants: Their Possible Association With Mandibular Cortical Index With 12-Month Follow-up.

BACKGROUND: The aim of the present study was to investigate whether the mandibular cortical index (MCI) has a relationship with fractal dimension of bone and/or implant stability, and to justify the possible association between MCI, fractal dimension, and stability. MATERIALS AND METHODS: Eighty-two subjects who received dental implants to replace missing mandibular premolar/molar sites were selected. Three months after surgical placement, implants were restored with fixed ceramic fused metal crowns. MCI was evaluated at baseline; fractal dimensions were measured with fractal analysis (FA) and implant stability quotient (ISQ) with resonance frequency analysis immediately after surgery and 12-month follow-up. RESULTS: FA at mesial and distal regions for Class 1, Class 2, and Class 3 MCI resulted with significant increases at 12-month follow-up compared to baseline. The ISQ in patients with Class 2 and Class 3 MCI resulted with a significant decrease compared to Class 1 MCI at baseline and at 12 months. All MCI classes evaluated with ISQ and FA at baseline values resulted with significant increases at 12 months. Significant correlations were considered for all mandibular posterior implants between baseline and 12-month measurements for ISQ and FA evaluations. CONCLUSIONS: Fractal analysis may be a useful method for understanding the healing process around implants and implant stability quotient values. Mandibular cortical index evaluations should be considered before implant procedures, which may provide a presurgical treatment plan and may provide information about the mandibular bone quality.

Apical/Retrograde Periimplantitis/Implant Periapical Lesion: Etiology, Risk Factors, and Treatment Options: A Systematic Review.

OBJECTIVES: To review the literature on retrograde periimplantitis symptoms, risk factors, and treatment methods and to propose a decision-making tree of retrograde periimplantitis management. MATERIALS AND METHODS: An electronic literature search was conducted on the MEDLINE and EMBASE databases for articles published between 1990 and 2015. Clinical human studies in the English language were included. RESULTS: The search resulted in 44 case reports published by 27 authors. The average time of the diagnosis of the pathology was found to be 26.07 weeks after implant placement (SD ± 39.7). Fistula formation was found to be the most common clinical symptom, statistically significantly more often occurring in the maxilla (P = 0.04). A negative correlation was found between pain and the adjacent tooth with incomplete endodontic treatment/endodontic pathology (r = -0.4; P = 0.009) and a positive correlation between the later risk factor and implant removal (r = 0.3; P = 0.028). Regenerative treatment (45.2% of the cases) or implant removal (35.7% of the cases) was the most common treatment techniques used. A decision-making tree of retrograde periimplantitis management is suggested. CONCLUSIONS: The etiology of retrograde periimplantitis is most often infectious. A decision-making tree aimed at managing patients with retrograde periimplantitis according to the possible etiology and symptoms of the disease can be a useful tool in the treatment of the pathology.

Descriptive study of mandibular canal visibility: morphometric and densitometric analysis for digital panoramic radiographs.

OBJECTIVES: To assess the visibility of the mandibular canal (MC) morphology in different jaw dental segments (JDSs) in relation to morphometric and densitometric parameters on digital panoramic radiographs (DPRs). METHODS: 32 DPRs (155 JDSs) were selected randomly after retrieval. MC visibility in conjunction with superior and inferior border visibility was scored on a 5-point scale in four places on the JDS-that is, for the medial, distal, superior and inferior MC parts. Morphometric and densitometric analyses were made horizontally and vertically in the JDS region. Descriptive statistics, Fisher's exact test, Mann-Whitney U test and additional tests were performed. RESULTS: There was no significant difference in MC visibility for the superior, inferior, medial and distal parts of the JDSs. Statistically significant (p < 0.05) differences were identified between particular visibility scores of the superior and inferior MC borders. In 22.0-24.7% of JDSs, the superior MC border was not visible, more than twice as often as the inferior MC border was not visible (9.1-10.2%). The visibility of superior and inferior MC borders in JDSs was not related to the morphometric or densitometric assessment parameters, or to age, gender, JDS location, condition or the visibility of neighbouring MC parts or contralateral JDSs. CONCLUSIONS: DPRs failed to provide MC visibility based on a single factor. Particular differences were identified between the levels of visibility of the superior and inferior MC borders. More advanced radiological investigation methods could be required for the evaluation of about 25% of JDSs when superior MC border identification is obligatory.

30-Year Outcomes of Dental Implants Supporting Mandibular Fixed Dental Prostheses: A Retrospective Review of 4 Cases.

PURPOSE: The aim of this study was to present the 30-year outcomes of 28 implants supporting mandibular screw-retained fixed dental prostheses (FDPs). MATERIALS AND METHODS: Dental charts of the 4 patients were carefully reviewed, and it was noticed that they received 28 implants and 5 screw-retained FDPs in 1983 and 1984. The chief concerns raised by these patients were poor retention of their complete dentures and decreased masticatory function at the time of treatment planning. Each dental care they received was recorded in the last 30 years. Implant survival, radiographic, and prosthodontic examinations were performed. RESULTS: No implants were lost after 30 years, giving the implant a survival rate of 100%. The average marginal bone level was 2.6 ± 0.5 mm at the last recall appointment. Of the 5 FDPs delivered, 1 needed replacement, indicating a prosthesis survival rate of 80%. The patients needed 21 repairs such as replacement of denture teeth/gold screws and hard relining, and 19 adjustments such as occlusal adjustments and acrylic resin contouring, over 30 years. CONCLUSION: This clinical report shows that machined-surface dental implants can successfully support screw-retained fixed dental prostheses for over 30 years, making dental implants an important dental treatment alternative compared to the traditional prosthetic treatment methods.

Effect of history of periodontitis on implant success: meta-analysis and systematic review.

PURPOSE: To determine if there is a relationship between history of periodontitis and dental implant success (used marginal bone loss [MBL] as the assessment criteria) and survival rates. MATERIALS AND METHODS: PubMed search was performed in the period between 2002 and 2012. Studies qualified for the inclusion should have ≥5 years followed-up and reported the incidence of peri-implantitis and/or implant survival and/or MBL in patients with and without a history of periodontitis. A meta-analysis was performed using the random-effects model on the selected qualified articles. RESULTS: All the 14 studies showed better implant survival rates for non-periodontitis patients' group. Six of 10 studies reported statistically significantly higher MBL and prevalence of peri-implantitis among periodontitis patients. Our meta-analysis did not find implant survival rates to be significantly lower among periodontitis patients (P = 0.99) but revealed a history of periodontitis to be significantly related to the higher prevalence of peri-implantitis (P < 0.001). CONCLUSIONS: There is no difference, in terms of implant survival rate, between periodontitis and non-periodontitis patients. However, patients with history of periodontitis had lower implant success rate (more MBL and incidence of peri-implantitis) when compared with non-periodontitis patients.

The impact of handicap severity on oral and periodontal status of patients with mental retardation.

AIM: Mental retardation (MR) subjects comprise a considerable amount of the community and are susceptible to oral and periodontal problems due to insufficient oral care. The aim of this cross-sectional study was to determine the oral health and periodontal status of MR patients in Turkey with regard to periodontal indices and Decay missed filling teeth (DMFT) scores and compare findings according to severity of the MR. MATERIALS AND METHODS: One hundred and five MR patients were included to the study and divided into 3 groups according to MR severity diagnoses. Demographic variables like age, gender, disabled sibling, BMI, living an institution and clinical parameters like plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), missing teeth and DMFT scores were recorded from all subjects. Appropriate statistical analyses were used to compare the findings. RESULTS: There were no statistically significant differences between groups according to age, gender, disabled sibling, living status and DMFT scores. Clinical periodontal indices and the number of missing teeth were showed a statistically significant increasing trend with the severity of MR (p < 0.05). Correlation analysis showed significant positive correlations between PI and periodontal disease measures like GI, PD, CAL and BOP and also between PI and DMFT (p < 0.05). CONCLUSION: The deteriorated teeth condition and deprived periodontal health of MR patients may be most likely caused by the poor oral hygiene and may be worsen with the severity of the MR. Clinical significance: Knowledge of oral and periodontal status of mental retardation patients has great importance for public health and family education.