Effects of different loading protocols on the bone remodeling volume of immediate maxillary single implants: A 2- to 3-year follow-up.

PURPOSE: The purpose of this study was to assess the effect of different loading protocols (immediate or delayed) on bone volume remodeling of an immediate implant-supported single crown in the maxilla with a follow-up from 2 to 3 years. MATERIALS AND METHODS: Patients presenting a failing tooth have been rehabilitated with implant-supported single crowns. Data of patients with a survey from 2 to 3 years after baseline surgery were retrospectively acquired. One implant per patient was randomly selected during data analysis and assigned to one of two predictor groups: the loading protocol, 9 immediate vs 13 delayed loading; and tooth position, 9 incisors vs 9 canines. Cumulative survival rates were recorded; loss of crestal bone volume was assessed with cone beam computed tomography (CBCT) by means of software that superimposed the preoperative and postoperative CBCT scan data (Matrix Laboratory) and by destascan software. RESULTS: Twenty-two patients were enrolled. No postoperative complications or implant failures were recorded. Bone volume loss from the 2- to 3-year follow-up period ranged between 19.1% and 22.0%, without significant differences between the two loading protocols. Irrespective of the tooth site, intragroup analyses revealed the presence of significant differences between preoperative and postoperative time evaluations for all the analyzed groups and subgroups. Volumes at baseline (ranging between 0.546 cc and 0.553 cc) recorded significant loss of approximately 110 mm3 (P values ≤ .0001) for both loading protocols. The volume at the postoperative evaluation ranged between 0.428 cc and 0.442 cc. Considering tooth site in the analysis, the subgroups showed similar behaviors at the crestal bone level. However, bone loss at the apex of the implant appeared to be lower for incisors than canines. CONCLUSION: This study attested that the loss of crestal bone around an immediate implant-supported single crown depended on neither the loading protocol nor the tooth site.

Treatment of chronic pain associated with bruxism through Myofunctional therapy.

Temporomandibular disorders such as bruxism may cause painful clinical conditions and over time lead to chronic facial pain. A combination of therapeutic strategies that are usually undertaken by dentists and gnathologists to reduce bruxism episodes and consequently pain, are myofunctional therapy, pharmacological treatment, intraoral interventions and behavioural treatments. The aim of this work was to understand if myofuntional therapy alone can be a useful therapy for the reduction of chronic facial pain. 24 patients, 9 male and 15 female, age ranging between 25 and 45, were treated with a myofunctional therapy for 9 month. Each patient was evaluated through a numeric pain intensity scale ranging from 0 to 10 and the number of bruxism episodes/hour per patient were also recorded; electromyographic examinations of the temporal, masseter, sternocleidomastoid and digastric muscles were performed to evaluate muscle activation. Each patient was tested before (T0) and after (T1) the treatment period. Pain intensity decreased from T0 to T1 (8.13±0.39 vs. 1.75±2.43, respectively, p<0.01). The number of bruxism episodes also significatively decreased between T0 and T1 (24 vs. 9, p<0.01). Electromyographic assessment showed a decrease in the tonic activity of the masseter muscle (T0: 1.88±0.31 vs. T1: 1.4±0.25 µV; p<0.05) and a reduction of the electric activity of the temporal and digastric muscles during serration of the mandible (T0: 167.9±19.6 µV Vs T1: 144.6+16.43 µV; p<0.05 and T0: 58.97+8.38 µV Vs T1: 52.79+7.44 µV; p<0.05, respectively). Myofunctional therapy could be used to reduce facial pain as a consequence of bruxism episodes.