Peri-implantitis and the Effect of the Implant Surface at Placement.

Modern root-form endosseous dental implants have been used to successfully replace missing teeth for more than four decades. The implant industry has grown substantially during this time, with many hundreds of dental implant manufacturers providing components for clinicians around the globe. Increased acceptance of dental implants has greatly amplified the number of dental implants placed worldwide. As the dental implant patient population continues to age, long-term follow-up after implant placement has become increasingly important due to various factors associated with the condition and maintenance of implants placed. Although dental implants exhibit a high success rate as a medical device, their life expectancy may be limited depending on the patient's changing health, use of medications, lifestyle changes, nutrition, occlusal/bite issues, loss of additional teeth, experiences of trauma, lack of sufficient keratinized soft tissue, loss of bony support, and oral hygiene habits. When loss of soft-tissue coverage and/or bone occurs, the resultant inflammation surrounding the implant is known as peri-implantitis.

Variety of Surgical Guides and Protocols for Bone Reduction Prior to Implant Placement: A Narrative Review.

Edentulism and terminal dentition are still considered significant problems in the dental field, posing a great challenge for surgical and restorative solutions especially with immediate loading protocols. When the implant placement is planned immediately after extraction with irregular bone topography or there is an un-leveled alveolar ridge topography for any other reason, bone reduction may be required to level the alveolar crest in order to create the desired bone architecture allowing for sufficient bone width for implant placement and to insure adequate inter-arch restorative space. Bone reduction protocols exist in analog and digitally planned methodologies, with or without surgical guides to achieve the desired bone level based upon the desired position of the implants with regard to the restorative outcome. The objective of this paper was to scrutinize the literature regarding the practice of bone reduction in conjunction with implant placement, and to review different types of bone reduction surgical guides. Results: The literature reveals different protocols that provide for bone reduction with a variety of bone reduction methods. The digitally-planned surgical guide based on Cone-Beam computerized tomography (CBCT) scan reconstructed data can improve accuracy, reduce surgical time, and deliver the desired bone level for the implant placement with fewer surgical and restorative complications. The clinician's choice is based on personal experience, training, and comfort with a specific guide type. Conclusions: Bone reduction, when required, is an indispensable step in the surgical procedure to attain suitable width of bone in anticipation of implant placement ideally determined by the desired tooth position and required restorative space based on material selection for the chosen framework design, i.e., hybrid, monolithic zirconia. Additionally, bone reduction and implant placement can be accomplished in the same surgical procedure, minimizing trauma and the need for two separate interventions.

Computer-Guided Approach for Placement of Zygomatic Implants: Novel Protocol and Surgical Guide.

PURPOSE: This study introduces a novel protocol for the placement of zygomatic implants utilizing presurgical planning with 3-dimensional (3D) computed tomography (CT)/cone-beam (CB)CT diagnostic technologies and advanced 3D printing through the development of a specific surgical guide. MATERIALS AND METHODS: The protocol relied on large field of view CT/CBCT for an accurate assessment of the maxillary arch to plan zygomatic implant receptor sites. CT/CBCT-derived surgical guides of a novel design were then fabricated using 3D printing technology. An exact replica of the entire maxilla and zygomatic bone was then fabricated in actual scale model size to allow for a simulation of the operation using replicas of implants to be used during the surgical intervention. Guidance was also provided for the sinus fenestration as part of the surgical template. Four patients received a total of 10 zygomatic implants all placed by the same surgeon. RESULTS: Preoperative positions of the zygomatic implants were compared with the postoperative implant positions by merging the pre- and postoperative CT scan datasets. The degree of accuracy of the superimposition was measured utilizing sophisticated software. Apical, coronal, and angular deviations were determined for each implant. Deviations from the computerized project to the actual implant positions ranged from 2 mm to 3 mm with angular deviations ranging between 1.88 and 4.55 degrees. CONCLUSIONS: Placement of zygomatic implants requires surgical experience due to close proximity of vital anatomical structures. This study used methods of superimposition that illustrated satisfactory correspondence between inserted implants and the virtual plan. No adjacent vital anatomical structures were damaged. The novel surgical guide design afforded the surgeon visual control of the drilling protocol. Positioning the guide in close proximity to the entry point of the zygomatic body aided control of the drills up to the vicinity of the exit point, significantly limiting problems associated with angular deviation. Reducing errors and complications is essential for zygomatic implants to remain a viable treatment alternative, and further research on a guided approach to their placement is encouraged.

The Root Membrane Technique: Human Histologic Evidence after Five Years of Function.

BACKGROUND: The "root membrane" (RM) is a technique that has become popular among implantologists for placement of immediate implants in the anterior maxilla. PURPOSE: To present histologic evidence of an immediate implant placed in the human anterior maxilla, according to the RM technique, and retrieved after five years. METHODS: A fixture, along with the surrounding tissues, was retrieved from the anterior maxilla of a 68-year-old patient, who had been treated five years earlier with immediate implant placement and RM technique. The specimen was processed for histologic/histomorphometric evaluation. RESULTS: The buccal bone plate was maintained without any resorption; a healthy periodontal ligament was evidenced. The implant showed osseointegration, with a high percentage of bone-to-implant contact (BIC = 76.2%). With regard to the space between the RM and the implant, the apical and medial thirds were filled with compact, mature bone; the coronal third was colonized by noninfiltrated connective tissue. CONCLUSIONS: The RM technique appears to be effective in preventing bone resorption of the buccal bone plate of the human anterior maxilla, five years after the placement of an immediate implant.

Rehabilitation of Full-Mouth Edentulism: Immediate Loading of Implants Inserted With Computer-Guided Flapless Surgery Versus Conventional Dentures: A 5-Year Multicenter Retrospective Analysis and OHIP Questionnaire.

OBJECTIVE: The purpose of this report is to compare satisfaction of patients rehabilitated with full-mouth fixed prostheses using computer-aided flapless implant placement and immediate loading with patients rehabilitated with conventional removable prostheses. MATERIALS AND METHODS: The study included 30 consecutive fully edentulous patients who received 312 implants and 30 matched controls treated with conventional removable prostheses. Mandible and maxilla were treated in the same surgical session with computer-guided flapless approach using NobelGuide protocol. Prefabricated screw-retained fixed prostheses were inserted at the end of surgery. Clinical and radiographic evaluations were assessed at 6, 12, and 36 months. At baseline and 5 years after prostheses delivery, patients answered OHIP-EDENT questionnaire (Oral Health Impact Profile for Edentulous subjects) to assess satisfaction. RESULTS: The implant survival rate was 97.9%, whereas the average marginal bone loss was 1.9 ± 1.3 mm after 3 years. At 6 months, patients showed significantly greater satisfaction with their fixed rehabilitation as compared to conventional dentures. CONCLUSIONS: The results of this study confirm that rehabilitation with a prefabricated fixed prosthesis supported by implants placed with NobelGuide protocol significantly increases the quality of life in fully edentulous patients when compared with complete dentures.

Three-dimensional imaging and guided surgery for dental implants.

Clinicians worldwide are increasingly adopting guided surgical applications for dental implants. Clinicians are becoming more aware of the benefits of proper planning through advanced imaging modalities and interactive treatment planning applications. All aspects of the planning phase are based on sound surgical and restorative fundamentals. As an integral part of the implant team, dental laboratories have now moved from analog to the digital world, providing the necessary support to the new digital workflow.

Use of an Intraoral Laser Scanner During the Prosthetic Phase of Implant Dentistry: A Pilot Study.

The accuracy of a digital impression technique to fabricate the implant restoration and abutment for a dental implant using an intraoral laser scanner was evaluated in 36 patients who were missing a single posterior tooth in either the mandible or maxilla that was restored with a single implant. The spatial position of each integrated implant, including the surrounding anatomic hard and soft tissues of adjacent structures, was captured utilizing a special scanning abutment with an intraoral laser scanner. Data from the scanning protocol was then delivered via the Internet in the form of an STL file to the manufacturing site for the production of a custom computer-aided design abutment and crown. All 36 restorations and abutments were delivered to the patients and evaluated for marginal integrity, interproximal contact points, and occlusion. Of the 36 patients, 6 required contact adjustments, 7 required occlusal adjustments, and 3 required a gingivectomy around the implant to completely seat the restoration. Chair time for adjustments did not exceed 15 minutes. The findings suggest that an intraoral laser scanner can be used with confidence to obtain consistent and accurate digital impressions to fabricate custom restorations and abutments for dental implants.

Evaluation of accuracy and precision of a new guided surgery system: a multicenter clinical study.

Computer-aided design/computer-assisted manufacture (CAD/CAM) guides for surgery are becoming a widespread tool in implant dentistry. This study sought to evaluate the accuracy and precision of a new guided surgery system. Twenty-five patients were treated in eight centers, and a total of 117 implants were placed using CAD/CAM surgical guides supported by bone, mucosa, and/or teeth. A postoperative computed tomographic (CT) scan of each patient was taken and superimposed on a preoperative CT scan to evaluate any discrepancies between the planned and actual implant positions (apex and platform positions), as well as the implant tilt. Implant placement using bone- and mucosa-supported guides was found to be more precise compared to using guides supported by teeth or a combination of teeth and mucosa. However, the differences were not statistically significant. The accuracy of the guided surgery system is in line with the data found in the literature. Considering the mean positioning discrepancies between the planned and actual implant outcomes, clinicians are advised to maintain a safe distance between implants and anatomical structures of at least 2 mm. In immediate loading cases, relining a provisional prosthesis to compensate for any discrepancies between the virtual and clinical implant positions is recommended.

Full-mouth rehabilitation with immediate loading of implants inserted with computer-guided flap-less surgery: a 3-year multicenter clinical evaluation with oral health impact profile.

OBJECTIVE: The purpose of this report is to present the clinical outcomes and patients' satisfaction of full-mouth rehabilitation using computer-aided flapless implant placement and immediate loading of a prefabricated prosthesis. MATERIALS AND METHODS: The study included 30 consecutive fully edentulous patients who received 312 implants. Mandible and maxilla were treated in the same surgical session with computer-guided flapless approach using the NobelGuide protocol. Prefabricated screw-retained fixed prostheses were inserted at the end of surgery. Clinical and radiographic evaluations were assessed at 6, 12, and 36 months. At baseline and 6 months after surgery, patients answered Oral Health Impact Profile in Edentulous Adults questionnaire to assess satisfaction. RESULTS: The implant survival rate was 97.9%, whereas the average marginal bone loss was 1.9 ± 1.3 mm after 3 years. At 6 months, patients showed significantly greater satisfaction with their fixed rehabilitation when compared with conventional dentures. CONCLUSIONS: The results of this study confirm that rehabilitation with a prefabricated fixed prosthesis supported by implants placed with NobelGuide protocol is a viable and predictable treatment and increases patients' satisfaction and improves oral health-related quality of life.

Dental implantology: an evolving treatment modality.

Diagnosis and treatment planning for dental implants has dramatically improved over the past three decades. Today's imaging technologies allow clinicians to assess individual patient-specific anatomy before the scalpel ever touches the patient.

The CT/CBCT-based team approach to care. Part I: Identiying the implant patient and prosthetic options.

Through a CBCT-based team meeting, the surgical team, restorative dentist, and laboratory team member can better coordinate dental implant treatment on many levels. Once the desired restorative result has been established through conventional means, the information can then be transferred via a radiographic template during the scan acquisition. The type of implant, angulation, width and diameter of the implant, and need for grafting, can be determined with great accuracy. This effective exchange of information can take place during an online meeting at a convenient time for all parties. The treatment planning that is possible within the framework of this digital workflow defines the essence of a team approach to implant reconstruction. The protocol as described in part I of this 3-part series allows for improved diagnosis, treatment planning, and successful clinical outcomes. Part 2 of this series will focus on the surgical aspects of the team approach, in collaboration with the restorative clinician and diagnostic imaging center.

Use of cone beam computed tomography and a laser intraoral scanner in virtual dental implant surgery: part 1.

OBJECTIVE: To describe a new procedure capable of coupling 2 data sets from cone beam computed tomography (CBCT) and an intraoral laser digital scanner to produce a stereolithographic model and surgical guide. METHODS: Use of DICOM (digital imaging and communications in medicine) format data obtained from CBCT scan images merged with standard triangulation language (STL) file data obtained from digital impressions using an intraoral laser scanner. The 2 data sets were electronically sent to a 3-dimensional imaging and technology software company over the Internet to fabricate a stereolithographic model of the jaws and surgical guide without the use of stone or plaster models obtained from traditional dental impressions. CONCLUSION: STL file data are able to accurately fabricate a stereolithographic model and surgical guide for implant surgery.

Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography.

A Position Paper Subcommittee of the American Academy of Oral and Maxillofacial Radiology (AAOMR) reviewed the literature since the original position statement on selection criteria for radiology in dental implantology, published in 2000. All current planar modalities, including intraoral, panoramic, and cephalometric, as well as cone beam computed tomography (CBCT) are discussed, along with radiation dosimetry and anatomy considerations. We provide research-based, consensus-derived clinical guidance for practitioners on the appropriate use of specific imaging modalities in dental implant treatment planning. Specifically, the AAOMR recommends that cross-sectional imaging be used for the assessment of all dental implant sites and that CBCT is the imaging method of choice for gaining this information. This document will be periodically revised to reflect new evidence.