Diagnostic reliability and accuracy of the hydraulic contrast lift protocol in the radiographic detection of sinus lift and perforation: ex vivo randomized split-mouth study in an ovine model.

OBJECTIVES: Assessing the diagnostic reliability, validity, and accuracy of the hydraulic contrast lift protocol during transcrestal sinus floor elevation in detecting the lift and perforation of the sinus membrane before graft material application and assessing the effect of its use on the operator's diagnostic confidence. MATERIAL AND METHODS: A single-blind randomized split-mouth study on fresh refrigerated sheep heads. The first intervention consisted of injecting 0.5 ml iodinated contrast medium on the test side and 0.5 ml saline on the control side. In the second intervention artificial sinus membrane perforations were created followed by injecting 0.5 ml iodinated contrast medium on the test side and 0.5 ml saline on the control side. Intraoperative periapical radiographs were taken for both interventions. The resulting 40 radiographs were assessed by 10 examiners to provide interpretations and confidence ratings. The primary endpoints were diagnostic reliability, validity, accuracy, and perceived diagnostic confidence. RESULTS: In the hydraulic contrast lift protocol, the detection rate was 99% for sinus elevations and 98% for perforations, the saline protocol yielded a detection rate of 28% and 20% respectively. The hydraulic contrast lift protocol demonstrated a high level of inter-rater agreement for the diagnosis of elevations (p < 0.001) and perforations (p < 0.001), strong diagnostic validity for the diagnosis of elevations (p < 0.001) and perforations (p < 0.001), high sensitivity and specificity (p < 0.001) and higher mean diagnostic confidence ratings for both interventions when compared to the saline protocol (p < 0.001). The difference between the predicted probability for correct diagnosis of the hydraulic contrast lift protocol and the saline protocol was significant (p < 0.001) for the detection of both elevations and perforations. CONCLUSION: Following the hydraulic contrast lift protocol, the use of a radiographic contrast medium can reliably confirm sinus membrane lift and detect perforation during transcrestal sinus floor elevation prior to bone graft application in addition to improving the diagnostic confidence of the operator while relying on periapical radiographs.

Evaluation of the Proximal Tibia as a Donor Site of Cancellous Bone for Intraoral Grafting Procedures-A Retrospective Study.

BACKGROUND: Autogenous bone grafts remain the "gold standard" in maxillofacial reconstructive procedures. The objective of this study was to evaluate the proximal tibia as a donor site of cancellous bone for bone grafting procedures of the mandible on the basis of intraoperative parameters and clinical observations. METHODS: The study was based on a medical record search of 40 patients who underwent surgical procedures because of benign pathological lesions of the jaws resulting in 3-wall bone defects of the mandible and qualified for surgical removal of the lesion with simultaneous bone grafting of the defect with autogenous cancellous bone harvested from the proximal tibia. RESULTS: The use of the proximal tibia for bone grafting procedures enables large amounts of cancellous bone (15.09 cc in average) to be obtained. The procedure is characterized by a low risk of early and late complications, which include excessive bleeding, wound infection, lengthy healing time, scars, a loss of sensation around the scars, aching, a dip in bone, swelling and tenderness. CONCLUSIONS: The ability to obtain large amounts of cancellous bone and a low risk of intra- and postoperative complications make the proximal tibia an attractive donor site for the bone grafting procedures in maxillofacial surgery.

Incidence and prevalence of peri-implantitis and peri-implant mucositis 17 to 23 (18.9) years postimplant placement.

PURPOSE: To evaluate the prevalence of peri-implantitis (PI) and peri-implant mucositis (PM) in a long-term follow-up with comparison among different PI and PM definitions, and to report on the incidence of PI. MATERIALS AND METHODS: In a retrospective clinical study five different PI and PM definitions were applied onto a population with 274 implants 17 to 23 years postimplant placement. Recommendations by the Eighth European Workshop on Periodontology (EWOP) were used as base reference. Clinical and radiological measurements were considered. Risk factors were evaluated in a regression analysis. RESULTS: After an average observation period of 18.9 years, 40.1% of the implants were diagnosed with PM and 15.0% with PI (Eighth EWOP). PI incidence reached 7.9% on implant level and 13.2% on patient level. Implants diagnosed with PI and progressive bone loss displayed exceptionally vertical bone defect configuration (BDC). Diabetes mellitus, smoking, regular maintenance, or a former periodontal infection did not show significant influence on the prevalence of peri-implant diseases. Patients with bruxism displayed significantly less PM and PI. CONCLUSIONS: Vertical BDC seems to correspond with active PI, wherefore we estimate such a defining factor of importance. Diagnosis of PM and evaluation of probing pocket depths might be only of descriptive interest as they could lead to false-positive results.

Periosteal Inhibition Technique for Alveolar Ridge Preservation as It Applies to Implant Therapy.

Alveolar ridge preservation procedures have been shown to significantly reduce the loss of ridge dimension of an extraction socket. As of yet, none of the alveolar ridge preservation techniques have been proven totally effective in preserving ridge morphology. The Periosteal Inhibition technique for alveolar ridge preservation involves placing a high-density polytetrafluoroethylene (d-PTFE) membrane between the periosteum and the buccal bone plate of an extraction socket. The authors hypothesize that the nonresorbable d-PTFE membrane, because of its much smaller pore diameter as compared to the size of the osteoclast precursor cells, inhibits the migration of the osteoclast precursor cells from the periosteum to the bony surface and, subsequently, their fusion to form osteoclasts. As a result, osteolytic activity on the outer surface of the socket is inhibited. The Periosteal Inhibition technique for alveolar ridge preservation is presented along with immediate implant treatment results using this treatment concept. The resulting stable ridge dimensions in these cases demonstrate a possibility that the d-PTFE membrane may effectively prevent modeling of the extraction socket by inhibiting the formation of osteoclasts on the outer bony surface.

Satisfaction level in dental-phobic patients with implant-supported rehabilitation performed under general anaesthesia: a prospective study.

BACKGROUND: Phobic patients avoid dental treatment impairing their oral health and making it challenging to offer them prosthetic rehabilitation. This study evaluated patients' experience of implant-supported prosthetic treatment after implantation performed under general anaesthesia due to dental phobia and severe pharyngeal reflexes (SPR). The effect of gender, age and location of implantation on patient satisfaction was tested. METHODS: Two hundred five patients underwent implantation under general anesthesia both in maxilla and mandible, respectively. After a trans-gingival healing period of 6-8 weeks, fixed implant bridges were inserted. Patients completed oral health impact profile questionnaire (OHIP-14). An additional set of six special questions was also developed and considered. Analysis of the OHIP-14 total score was made using logistics regression. Wald chi-square test was used to analyse the effect of age, gender and location of implantation. Effect sizes were estimated as odds-ratios and associated 95% Wald confidence intervals. RESULTS: Eighty two of 205 patients were included after prosthetic treatment. After start, 38 patients were excluded (4 died and 34 couldn't be reached). OHIP-14-analyses were made by 43 patients (30-90 years). 67% of patients were totally satisfied with the whole implant rehabilitation (scoring 0). Mean of total score was 2.5. Only age affected significantly (p = 0.014) patients satisfaction. The obtained data indicate that younger patients (30-64 years) especially women are less satisfied (4.95) than older patients (0.3) for age group (65-90 years).Special questions' data showed that 94.5% were satisfied with their treatment. 77.3% continued regular check-up after treatment and 96.9% would undergo the same treatment again. 95.5% would recommend implants to a friend of colleague. CONCLUSION: Gender and location of implantation have no significant influence on patient satisfaction. Younger patients especially women are less satisfied than older patients. Phobic patients are totally satisfied with implant rehabilitation under general anaesthesia which means that this treatment can be considered as a treatment of choice giving these patients the same opportunity like others to improve their oral health and well-being.

Lateral sinus floor elevation without grafting materials. Individual- and aggregate-data meta-analysis.

PURPOSE: To perform a systematic review and individual- and aggregate-data meta-analysis of observational studies to determine the success rate of the lateral sinus floor elevation with simultaneous implant placement and without grafting materials. MATERIAL AND METHODS: We included prospective and retrospective observational studies analyzing survival rate of implants in patients who underwent graftless lateral sinus floor elevation. Secondary outcomes included increase of bone height, marginal bone loss (MBL), implant stability, and adverse events such as sinus membrane perforation and signs of infection in the maxillary sinuses. Survival rate and proportion of adverse outcomes were calculated using the variance-stabilizing Freeman-Tukey double-arcsine transformation. Meta-analyses of bone gain and MBL were performed based on changes from baseline and sampling variance. Implant stability was analyzed at follow-up. Individual participant data were modeled using a one-step approach. The survival probability was determined using the Kaplan-Meier method, and the Cox proportional-hazards regression was applied to investigate the association between survival time of implants and covariates. RESULTS: 11 observational studies were included in the study. The meta-analysis based on 660 implants and 17 failures showed a pooled survival rate of 97.5% (CI 95% 95.8 to 98.9). Pooled analysis also showed an increase in mean bone height of 5.7 mm (CI 95% 4.78 to 6.56), MBL of 1.2 mm (CI 95% 0.84 to 1.51), and implant stability quotient of 70.5 (CI 95% 64.2 to 76.9). A pooled rate of 20.0% (CI 95% 10.9 to 30.6) and 3.0% (CI 95% 0.5 to 6.8), respectively, for membrane perforations and sinus infection was found. Individual-data meta-analysis showed an overall 5-year survival of 93.1% (SE 2.67%) with a mean survival time of 6.7 years (SE 0.08). Longer implants were associated with a decreased hazard ratio (0.64; CI 95% 0.41 to 0.99). CONCLUSIONS: Current available evidence based on aggregate and individual patient data meta-analysis suggests that lateral maxillary sinus floor elevation without grafting, and simultaneous implant placement, is a safe and effective technique with high survival rates, especially for implants with more than 13 mm in length.

One Abutment at One Time Concept for Platform-Switched Morse Implants: Systematic Review and Meta-Analysis

Abstract The aim of this systematic review and meta-analysis was to compare the peri-implant vertical bone loss of immediate loading of implant crowns using the one abutment at one time (AOT) protocol and implants with abutment removal (AR). This systematic review with meta-analysis was reported according to the PRISMA statement, with guidance from the Cochrane Collaboration Handbook. A total of 103 publications were identified in the PubMed database and reference lists of examined articles. After the screening of titles and abstracts, the eligibility of eight full-text articles was assessed. Five studies published between 2010 and 2015 were included in the meta-analysis. There was less peri-implant vertical bone loss at implants using an AOT protocol than at implants using AR protocol (WMD -0.19, 95% CI -0.26 to -0.13; p<0.0001; random-effects model). In conclusion, the use of the AOT protocol with platform-switched Morse implants results in less bone loss than do AR procedures, but this effect may not be clinically relevant. The preservation of marginal bone level achieved with the AOT protocol may not enhance the aesthetics. These results should be interpreted with caution.

Resumo O objetivo desta revisão sistemática e meta-análise foi comparar a perda óssea vertical em implantes de carga imediata usando o protocolo de um pilar em um único momento (AOT) e implantes com remoção de pilar (AR). Esta revisão sistemática com meta-análise foi relatada de acordo com a declaração PRISMA, com orientação do Cochrane Collaboration Handbook. Foram identificadas 103 publicações na base de dados PubMed e nas listas de referência dos artigos examinados. Após a triagem de títulos e resumos, avaliou-se a elegibilidade de oito artigos de texto completo. Cinco estudos publicados entre 2010 e 2015 foram incluídos na meta-análise. Houve menos perda óssea vertical peri-implante em implantes usando o protocolo AOT do que nos implantes usando o protocolo AR (WMD -0,19, 95% IC -0,26 a -0,13; p <0,0001, modelo de efeitos aleatórios). Em conclusão, o uso do protocolo AOT com implantes Cone Morse associados a pilares com plataforma switching resulta em menos perda óssea do que os procedimentos AR, mas esse efeito pode não ser clinicamente relevante. A preservação do nível ósseo marginal alcançado com o protocolo AOT pode não melhorar a estética. Estes resultados devem ser interpretados com cautela.

Response of soft tissue to different abutment materials with different surface topographies: a review of the literature.

Soft tissue integration in the transmucosal zone of dental abutments supports the peri-implant tissues, improves esthetics, ensures soft tissue seal against microorganisms, and preserves crestal bone level. The aim of this literature review was to define the most favorable surface topography and macrodesign of the transmucosal zone of abutments to achieve optimal soft tissue seal. An electronic search of the PubMed/MEDLINE database was performed, seeking relevant English-language articles published between January 1, 2003, and October 11, 2014. The key terms implant abutment, surface topography, and soft tissue seal were used both singly and jointly with "AND" in this search. Additionally, a manual search was performed. Articles that did not distinguish between abutment and implant surfaces, investigated only 1-piece dental implants, or were systematic reviews were excluded, although 4 systematic reviews were studied to obtain background information. Out of a preliminary pool of 206 articles, 12 relevant articles were identified for final evaluation in addition to the 4 systematic reviews. These included 3 human studies, 3 animal studies, and 6 in vitro studies. The human histologic studies showed evidence of perpendicular insertion of human gingival fibroblasts into the treated abutment surface. Laser-ablated, hydrophilic, and oxidized titanium surfaces resulted in this type of attachment. Epithelial cells seem to slightly favor zirconia and polished titanium surfaces. Due to heterogeneity in the study designs, statistical methods, and reported results, meta-analysis of the data was not possible. Improvements in the surface topography and macrodesign of dental abutments might improve biocompatibility and adherence to soft tissue; however, manipulation of soft tissue and second-stage surgery could negate any advantages of the improved surfaces.

One Abutment at One Time Concept for Platform-Switched Morse Implants: Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to compare the peri-implant vertical bone loss of immediate loading of implant crowns using the one abutment at one time (AOT) protocol and implants with abutment removal (AR). This systematic review with meta-analysis was reported according to the PRISMA statement, with guidance from the Cochrane Collaboration Handbook. A total of 103 publications were identified in the PubMed database and reference lists of examined articles. After the screening of titles and abstracts, the eligibility of eight full-text articles was assessed. Five studies published between 2010 and 2015 were included in the meta-analysis. There was less peri-implant vertical bone loss at implants using an AOT protocol than at implants using AR protocol (WMD -0.19, 95% CI -0.26 to -0.13; p<0.0001; random-effects model). In conclusion, the use of the AOT protocol with platform-switched Morse implants results in less bone loss than do AR procedures, but this effect may not be clinically relevant. The preservation of marginal bone level achieved with the AOT protocol may not enhance the aesthetics. These results should be interpreted with caution.

Lateral Alveolar Ridge Expansion in the Anterior Maxilla Using Piezoelectric Surgery for Immediate Implant Placement.

PURPOSE: The purpose of this study was to evaluate the efficacy of the ridge-splitting technique in the anterior maxilla, using piezoelectric surgery for immediate implant placement. Study outcomes were compared with those of implant placement in the same patients using the conventional drilling technique. MATERIALS AND METHODS: Ten patients received a total of 22 implants in the anterior maxilla, 11 of which were placed using a ridge-splitting procedure (test group) and the other 11 using the conventional drilling procedure (control group). Ridge width (RW), crestal bone level (BL), and implant stability quotient (ISQ) were measured at different points in time. Data were analyzed and compared between the groups using analysis of variance (ANOVA) and paired-sample t tests at a significance level of 5%. RESULTS: For the test group, the gain in RW was not stable in time because at 6 months postoperatively, the RW lost some of the initial gain; however, the net gain was still significant. At 6 months postoperatively, BL was similar for both groups. The net bone loss on the mesial aspect and the average of the mesial and the distal measures did not differ significantly between both groups. ISQ values sharply increased at 3 months postoperatively in the test group. All implants met the modified Albrektsson criteria (1989) for success. CONCLUSION: The results from this study support the efficacy and safety of ridge expansion using piezoelectric surgery for implant insertion in the anterior maxilla. The modest net gain in bone width suggests that additional hard and soft tissue augmentation may be necessary, especially in the esthetic zone. ISQ values suggest a minimum healing time of 3 months before loading the implants that have been inserted using this ridge-splitting protocol.