Adjuvant Effect of Titanium Brushes in Peri-Implant Surgical Treatment: A Systematic Review.

BACKGROUND: the prognosis of peri-implant surgery can be affected by poor decontamination of the implant surface, which could be improved with the use of titanium brushes. The objectives of this systematic review were to evaluate the effectiveness of titanium brushes in the decontamination of the implant surface in terms of plaque index, probing depth, bleeding on probing and bone loss/gain; as well as its effectiveness according to the type of peri-implant bone defect. METHODS: an electronic search was carried out in the PubMed, Scopus, Cochrane and Embase databases, as well as a manual search. The search strategy included four keywords: "Peri-implantitis", "Periimplantitis", "Implant Surface Decontamination" and "Titanium Brush". Randomized controlled studies published in the last 10 years were included and systematic reviews, in vitro studies and animal studies were excluded. RESULTS: 142 references were found, from which only four articles met the inclusion criteria. All of the studies included in the present review reported beneficial results in terms of probing depth, gingival index and radiographic bone loss and gain after implant surface decontamination adjuvated by titanium brushes. CONCLUSIONS: titanium rotary brushes show improvements in the evolution and prognosis of peri-implant surgery, although more long-term studies are needed to draw more solid conclusions.

Osteotome sinus floor elevation without grafting material: Results of a 2-year prospective study.

OBJECTIVES: The aim of this prospective clinical trial was to evaluate the success implant rates during 24 months using OSFE procedure without grafting materials. STUDY DESIGN: 42 adult patients (22 female, 15 male) were selected according to Nedir et al´s inclusion criteria of which 5 patients were excluded, due to periapical pathology in adjacent teeth (n=3) and treatment with bisphosphonates (n=2). 37 patients aged 31-68 years were selected. Smokers were divided in two groups depending on the number of cigarettes consumed per day (a) 0-10, (b) 11-20. One patient was excluded because he was lost to follow-up at 24 months A total of 36 threaded implants were placed, ∅4,1mm Straumann® (Straumann AG, Waldenburg, Switzerland) and ∅3,5mm Klockner® (Klockner Implant System, Barcelona, Spain). The most used implant diameter was 4,1 mm (n=29), followed by 3,5 mm (n=7), and length used was 10 mm (n=32) and 8 mm (n=4). Initial RBH ranged from 4 mm to 9 mm. All statistical data were processed using the program R 3.0.2 for windows. RESULTS: A total of 36 threaded implants were placed. Residual bone height (RBH) at implant placement averaged 7,4 ± 0,4 mm. Mean bone gain was 1,8 ± 0,3 mm. Four implants showed a bone gain exceeding 3 mm. Mean implant protrusion length into the sinus amounted to 2.1 ± 0,3 mm. Regarding the relationship between smoking and periodontal probes, no statistically significant differences were found (P=0,25), neither in relation to the number of threads that the implants showed (P=0,29) or bone gain (P=0,79). After 24 months the implant success rate was 91,6%. CONCLUSIONS: Implant rehabilitation of edentulous atrophied posterior maxilla can be safely performed and simplified using the OSFE technique without grafting with reliable long-term results. Key words:Crestal bone loss, dental implants, internal sinus lift, no grafting, osteotome sinus elevation, grafting, sinus floor elevation.

Influence of oral hygiene and smoking on pain and swelling after surgical extraction of impacted mandibular third molars.

PURPOSE: To assess the pain and swelling during the first week after surgical extraction of impacted mandibular third molars and the relationship with oral hygiene and smoking before surgery and during the postoperative period. MATERIALS AND METHODS: A prospective study was performed on patients undergoing surgical extractions of impacted mandibular third molars. Pain was recorded on a visual analog scale from 1 to 10 and swelling on a 4-point descriptive scale at 2, 6, and 12 hours after surgery and daily during the first postoperative week. Oral hygiene and smoking before surgery and during the postoperative period were recorded. Statistical analysis was performed of all the variables. A P value less than .05 was considered statistically significant. RESULTS: A total of 50 patients (27 men and 23 women) with a mean age of 26.3 years (range 18 to 39) underwent surgical extraction of an impacted third molar. The maximum pain occurred during the first day and the maximum swelling at 24 hours after surgery. The patients with a lower brushing frequency before surgery reported greater pain. Likewise, the patients who smoked more after surgery experienced greater pain at 24 hours postoperatively. The hygiene after surgery and smoking before the surgical intervention had no statistically significant relationship to the occurrence of pain (P > .05). Swelling had no relationship with the variables studied (P > .05). CONCLUSIONS: Surgical extraction of an impacted third molar caused moderate pain and swelling during the first 24 hours after surgery. A lower brushing frequency before surgery and during the first postoperative week as well as smoking after surgery were related to greater pain scores.

Immediate implants after the removal of maxillary impacted canines: a clinical series of nine patients.

PURPOSE: When impacted maxillary canines are not amenable to orthodontic traction or reimplantation, extraction is the only solution available, followed by the option of implant placement. The aim of this study was to present a surgical technique that allows placement of immediate implants following extraction of impacted maxillary canines. MATERIALS AND METHODS: Included in the study were patients with impacted maxillary canines who refused orthodontic treatment or transplantation and/or in whom the position of the canine teeth did not allow fenestration and orthodontic traction. The canines were removed, with the apical and ridge crest bone preserved to allow immediate implant placement anchored bicortically with good primary stability. The full circumference of the implants had no bone coverage except for the apical and coronal parts and were covered with bone shavings collected by the filter of the surgical aspirator during ostectomy. The definitive restorations were positioned after a healing period of 2 to 3 months. After 12 months, data were recorded relating to the clinical and radiographic condition of the implants. RESULTS: Ten impacted maxillary canines were extracted from nine patients (in one patient, both impacted maxillary canines were extracted) with a mean age of 40.3 years (range, 32 to 63 years), and 10 immediate implants were placed. All the implants had primary stability with a mean Osstell value of 61.5 on the day of surgery. At 12 months of follow-up, all the implants were considered to be successful. Digital periapical radiographs demonstrated a mean peri-implant bone loss of 0.49 mm (range, 0.15 to 1.1 mm). CONCLUSION: The removal of impacted canines followed by immediate implant placement minimizes the number of surgical interventions and the waiting time, although increased surgical skill is needed to place the implants.

Pain and swelling in periapical surgery. A literature update.

In recent years, periapical surgery (PS) has evolved thanks to the incorporation of technical and diagnostic advances. In PS, secondary effects such as pain and swelling occur as with all surgical procedures. The objective of the present study is to review the literature of articles published on pain and swelling during the postoperative period in periapical surgery. For this review, a search was made in Medline and of literature published in Spanish odontological journals. In the reviewed literature the maximum pain was produced during the first 24 postoperative hours and maximum swelling between the first and second day. Recent studies propose the use of corticoids and nonsteroidal anti-inflammatory drugs (NSAIDs) during the pre-and post-operative period, in order to reduce pain perception during the first postoperative week after surgery. Likewise, low-level laser therapy has been used; although with no statistically significant results being observed for the control of pain. In the majority of published studies there was no statistically significant relationship between age and sex and the postoperative symptoms. However, greater pain and swelling is observed in patients with poor oral hygiene before surgery, and higher pain in patients who smoke, and in those with pain before surgery. Surgery of anterior teeth and molars is associated with greater pain.

Pain and swelling in periapical surgery. A literature update

In recent years, periapical surgery (PS) has evolved thanks to the incorporation of technical and diagnostic advances. InPS, secondary effects such as pain and swelling occur as with all surgical procedures. The objective of the present studyis to review the literature of articles published on pain and swelling during the postoperative period in periapical surgery.For this review, a search was made in Medline and of literature published in Spanish odontological journals.In the reviewed literature the maximum pain was produced during the first 24 postoperative hours and maximumswelling between the first and second day. Recent studies propose the use of corticoids and nonsteroidal anti-inflammatorydrugs (NSAIDs) during the pre-and post-operative period, in order to reduce pain perception during thefirst postoperative week after surgery. Likewise, low-level laser therapy has been used; although with no statisticallysignificant results being observed for the control of pain. In the majority of published studies there was no statisticallysignificant relationship between age and sex and the postoperative symptoms. However, greater pain and swelling isobserved in patients with poor oral hygiene before surgery, and higher pain in patients who smoke, and in those withpain before surgery. Surgery of anterior teeth and molars is associated with greater pain (AU)

Restoration with implants in patients with recessive dystrophic epidermolysis bullosa and patient satisfaction with the implant-supported superstructure.

PURPOSE: The use of endosseous implants in the prosthetic restoration of edentulous patients with recessive dystrophic epidermolysis bullosa (RDEB) may provide improved outcomes when compared with traditional prosthetic methods. The aim of this study was to evaluate the feasibility of placing endosseous implants in patients with RDEB and to compare the treatment outcomes of fixed and removable implant-supported restorations in the edentulous maxilla or mandible with the main emphasis on patient response. MATERIALS AND METHODS: Six patients with RDEB were treated with implants. All patients were completely edentulous in either the maxilla or mandible and had marked oral involvement, with alterations in the soft and hard tissues in all cases. Three patients were treated with fixed, screw-retained implant-supported prostheses, and 3 were treated with removable implant-supported prostheses. Six months after prosthetic restoration, patients were given a questionnaire to assess their psychologic well-being and satisfaction with the implant-supported restoration marked on a visual analog scale. RESULTS: A total of 38 dental implants (21 maxillary, 17 mandibular) were placed in 6 patients. The implant success rate was 97.9%. The average follow-up from implant placement was 5.5 years (range, 1 to 9). The fixed and removable implant-supported prostheses were associated with improvements in comfort and retention, function, esthetics and appearance, taste, speech, and self-esteem. The level of satisfaction was slightly higher in patients with a fixed prosthesis. CONCLUSION: These findings suggest that endosseous implants can be successfully placed and provide support for prostheses in patients with RDEB. Patients with fixed prostheses and overdentures were satisfied with their implant-supported prostheses in the edentulous maxilla and mandible.