44,499 research outputs found
Complications and treatment errors in periodontal and implant therapy
No full textThe assortment of periodontal and implant-related treatments has been continuously improved over the last 50 years. Once the decision-making process has been established and the treatment procedure applied, the partial or complete resolution of the problem (eg, periodontal probing depth reduction, clinical attachment level gain, gingival recession reduction, dental hypersensitivity decrease) and a diagnosis change with no or minimal occurrence of adverse events (ie, complications, harms, technical errors, or adverse/side effects) can be expected. The clear identification of the potential types of adverse effects, complications, or even errors is important for contemporary decision-making processes, as they may be related to different local, systemic, and technical aspects. This chapter focused on four core components: (a) providing periodontal definitions for errors, complications, harms, and side effects; (b) defining the types of risk and the clinical impact of adverse effects, errors, and complications in periodontal and peri-implant therapies; (c) evaluating the influence of accidental errors versus the lack of a proper treatment planning; and (d) reporting on the importance of establishing the “net benefit ratio” between the clinical improvements promoted by the therapy and the occurrence of potential adverse events.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/177641/1/prd12442.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/177641/2/prd12442_am.pd
Topographic Assessment of Calcified Material After Sinus Floor Augmentation
No full textPurpose: This study aimed to topographically examine the healing of mineralized human bone allograft in sinus augmentation. Materials and Methods: Thirty-two patients with crestal bone height <= 2 mm who required sinus augmentation were recruited for the study. A mixture of 80/20 cortical/cancellous mineralized human bone allografts were used to augment the sinus floor using a crestal window approach. A bone core biopsy specimen was taken at the time of implant placement, 6 months after surgery. Microradiographs of methacrylate-embedded sections were split into five longitudinal sectors (crestal to sinusal) to topographically assess the bone, graft, and fibrous tissue amount. Results: All implants were osseointegrated 3 months later without any adverse effects. The polynomial (degree 2) of results (all with great correlation coefficient, P < .01) gave rise to a polynomial curve of graft percentage with a maximum at sector 4 (presinusal), a bone percentage with a minimum between sectors 3 and 4, and a fibrous tissue percentage with a maximum between sectors 3 and 4. Conclusion: Based upon topographic analysis, mineralized human bone allograft is capable of achieving adequate vertical bone height for implant placement. The need for a topographic analysis to assess the outcomes of sinus augmentation is emphasized. Int J Oral Maxillofac Implants 2021;36:1219-1223. doi: 10.11607/jomi.756
Alveolar ridge preservation: Complications and cost-effectiveness
No full textAlveolar ridge preservation is routinely indicated in clinical practice with the purpose of attenuating postextraction ridge atrophy. Over the past two decades numerous clinical studies and reviews on this topic have populated the literature. In recent years the focus has primarily been on analyzing efficacy outcomes pertaining to postextraction dimensional changes, whereas other relevant facets of alveolar ridge preservation therapy have remained unexplored. With this premise, we carried out a comprehensive evidence-based assessment of the complications associated with different modalities of alveolar ridge preservation and modeled the cost-effectiveness of different therapeutic modalities as a function of changes in ridge width and height. We conclude that, among allogeneic and xenogeneic bone graft materials, increased expenditure does not translate into increased effectiveness of alveolar ridge preservation therapy. On the other hand, a significant association between expenditure on a barrier membrane and reduced horizontal and vertical ridge resorption was observed, though only to a certain degree, beyond which the return on investment was significantly diminished
Influence of tooth location on coronally advanced flap procedures for root coverage
No full textBACKGROUND: The efficacy of Coronally Advance Flap (CAF) has been extensively evaluated and several parameters influencing the results, such as interproximal attachment loss, recession defect size, papilla dimension, flap thickness, have also been identified. However, the influence of tooth location has not been systematically investigated yet. Therefore, the aim of this systematic review was to evaluate the influence of tooth location on the outcomes of CAF. METHODS: A literature search on PubMed, EMBASE, Cochrane libraries and hand-searched journal until September 2017 was performed to identify clinical studies reporting the outcome of CAF for localized gingival recessions (GRs) for each single tooth. RESULTS: Eighteen articles reporting 399 localized GRs treated with CAF were included in the present systematic review. Canines and incisors were related to a higher mRC and CRC than premolars and molars (odds ratio 1.63) (p 0.05). The addition of a graft such as Connective Tissue Graft (CTG) with or without Enamel Matrix Derivative (EMD) was shown to enhance the outcomes compared to CAF alone (p 0.05). CONCLUSIONS: Tooth location plays an important role on mRC and CRC following CAF. The addition of CTG or substitutes, especially with biological agents (EMD), enhance the clinical outcomes compared to CAF alone
Implant placement in the esthetic area: criteria for positioning single and multiple implants
No full textPatient expectations from implant treatment have changed over the years and esthetics plays an important role in defining what is now called success of rehabilitation. Of the many factors that influence the outcome of the rehabilitation, the two main ones are the bone and soft-tissue deficiencies at the intended implant site. Many surgical approaches are described in terms of timing of implant placement and management of regenerative procedures. The aim of this article is to discuss the different implant placement alternatives in the esthetic area, in particular: (i) the timing of implant placement/regenerative procedures/skeletal growth/altered passive eruption; (ii) the correct three-dimensional position of the fixture between the cuspids and in the premolar area; (iii) multiple missing teeth in the esthetic area with single tooth/pontic or cantilevered options/prosthetic compensation; (iv) placement of implants into infected sites; and (v) the influence of abutment and crown morphology on implant position. Combining our long-standing clinical experience and the pertinent literature, the following conclusions can be drawn: Immediate implant placement can be a successful procedure in terms of esthetics but it is technique sensitive and requires an experienced team. Immediate placement is less traumatic to the patient as fewer surgical procedures are involved and patients tend to prefer this clinical approach with regards to quality of life. The diagnostic phase is of utmost importance, with not only bone and soft tissue deficiencies being addressed but also: skeletal growth, dental/implant soft tissue parameters such as altered passive eruption and the morphology of the roots adjacent to the edentulous area. Post-extraction immediate loading is feasible in infected sites. The correct position of the fixture should follow widely accepted guidelines but the abutment morphologies play a role in the vestibular/palatal position of the implant. The long axis of the implant, aiming at the incisal edge of the future restorations, is the most appropriate implant position when a shoulder-less abutment is used and allows a restorative crown morphology with a cervical contour resembling a natural tooth. The use of a shoulder-less abutment gives more space for the tissue to grow compared with the traditional abutment with shoulder finish line
Vertical soft tissue augmentation to treat implant esthetic complications: A prospective clinical and volumetric case series
No full textIntroductionChallenging implant esthetic complications are often characterized by implant malpositioning and interproximal attachment loss of the adjacent teeth. However, limited evidence is available on the treatment of these conditions. The aim of this study was to evaluate the clinical, volumetric, and patient-reported outcome following treatment of peri-implant soft tissue dehiscences (PSTDs) exhibiting interproximal attachment loss on adjacent teeth, performed through vertical soft tissue augmentation with implant submersion.MethodsTen subjects with isolated PSTD in the anterior maxilla characterized by adjacent dentition exhibiting interproximal attachment loss were consecutively enrolled and treated with horizontal and vertical soft tissue augmentation, involving crown and abutment removal, two connective tissue grafts, and submerge healing. Clinical outcomes of interest included mean PSTD coverage, mean PSTD reduction, clinical attachment level (CAL) gain at the implant and adjacent sites and soft tissue phenotype modifications at 1 year. Optical scanning was used for assessing volumetric changes. Professional assessment of esthetic outcomes was performed using the Implant Dehiscence coverage Esthetic Score (IDES), while patient-reported esthetic assessment involved a 0–10 visual analogue scale.ResultsThe mean PSTD depth reduction and mean PSTD coverage at 1 year were 2.25 mm, and 85.14%, respectively. A mean keratinized tissue width (KTW) gain of 1.15 mm was observed, while the mean gain in mucosal thickness (MT) was 1.58 mm. A mean CAL gain of 1.45 mm was obtained at the interproximal aspect of the adjacent dentition at 1 year. Greater linear dimensional (LD) changes were observed at the midfacial aspect of the implant compared to the interproximal sites. The mean final IDES was 6.90 points, while patient-reported esthetic evaluation was 8.83 points.ConclusionsThe present study demonstrated that vertical soft tissue augmentation with a submerged healing is an effective treatment approach for the treatment of challenging PSTDs with adjacent dentition exhibiting interproximal attachment loss. This technique can be effective in resolution of esthetic complications in most cases, providing a substantial gain in interproximal attachment levels at the adjacent dentition.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/176261/1/cid13188_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/176261/2/cid13188-sup-0001-AppendixS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/176261/3/cid13188.pd
Wound healing dynamics, morbidity, and complications of palatal soft-tissue harvesting
No full textPalatal-tissue harvesting is a routinely performed procedure in periodontal and peri-implant plastic surgery. Over the years, several surgical approaches have been attempted with the aim of obtaining autogenous soft-tissue grafts while minimizing patient morbidity, which is considered the most common drawback of palatal harvesting. At the same time, treatment errors during the procedure may increase not only postoperative discomfort or pain but also the risk of developing other complications, such as injury to the greater palatine artery, prolonged bleeding, wound/flap sloughing, necrosis, infection, and inadequate graft size or quality. This chapter described treatment errors and complications of palatal harvesting techniques, together with approaches for reducing patient morbidity and accelerating donor site wound healing. The role of biologic agents, photobiomodulation therapy, local and systemic factors, and genes implicated in palatal wound healing are also discussed
Regenerative treatment of peri-implantitis: A comparison of the reinforced PTFE mesh (RPM) and the collagen membrane in the submerged approach: a randomized controlled clinical trial
No full textObjective: This randomized controlled clinical trial aimed to compare the clinical and radiographic regenerative outcomes of two types of barrier membranes, absorbable collagen membrane and reinforced PTFE mesh (RPM), in the surgical treatment of peri-implantitis, utilizing a submerged healing protocol.
Materials and Methods: This double-blinded, single-center, parallel-arm randomized controlled clinical trial compared the regenerative outcomes of two barrier membranes, collagen (control) and reinforced PTFE mesh-RPM (test), in the surgical treatment of peri-implantitis. Fifteen patients were randomized into two groups: the control group (collagen membrane, n=8) and the test group (RPM membrane, n=7). Both groups received standardized surgical regenerative therapy, including implant surface decontamination, bone grafting, and primary wound closure. Clinical outcomes were assessed at baseline (crown removal and surgical procedure) and 8 months postoperatively and included probing depth (PD) - only at baseline, bleeding on probing (BOP), plaque index (PI), gingival index (GI), soft tissue thickness, and patient phenotype (only at baseline). Defect measurements included radiographic defect height (RDH), clinical defect height (DH), defect width (DW), suprabony (SD), and infrabony (ID) defects. Radiographic bone fill was measured using standardized periapical radiographs. Patient-reported outcomes included VAS pain scores (daily for 14 days). Statistical analysis involved Shapiro-Wilk, t-tests, Mann–Whitney U, Wilcoxon, Chi-square/Fisher’s tests, McNemar tests, and mixed linear regression modeling, with significance set at α = 0.05.
Results: Fifteen patients completed the study (8 control, 7 test). Both groups were homogeneous at baseline. The collagen membrane group showed significantly greater improvements in RDH (p=0.003), DH (p=0.009), and SD (p= 0.0008). While reductions in DW showed a trend toward significance (p=0.06), ID reduction was more favorable in the test group (p=0.03). GI and PI improved similarly in both groups without significant differences. The RPM group experienced a 100% membrane exposure rate, with 71.4% occurring early, which likely compromised regenerative outcomes. Postoperative pain scores were comparable between groups.
Conclusion: The collagen membrane outperformed the RPM membrane in terms of clinical and radiographic outcomes when used in submerged regenerative therapy for peri-implantitis. The high exposure rate associated with the RPM membrane may have adversely affected healing. These findings underscore the importance of membrane selection in GBR procedures, where wound stability and exposure risk critically influence treatment success.Master of Science (MS)PeriodonticsUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/198087/1/Rafael Pereira Thesis.pd
New Biomaterials and Regenerative Medicine Strategies in Periodontology, Oral Surgery, Esthetic and Implant Dentistry 2016
No full textComparison of immediate versus delayed implant placement in a failed implant site: A retrospective analysis of early implant survival
No full textPurpose: To compare immediate and delayed implant replacement at failed implant sites to evaluate the factors associated with early failure of second implants after replacement. Materials and methods: Data regarding early implant failure followed by replacement with another fixture in a private practice setting between 2003 and 2019 were analysed retrospectively. Early failure was defined as loss of the dental implant within 6 months of placement. The impact of patient-level (age, sex, diabetes, smoking history) and implant-level (timing of implant replacement, timing of prosthetic loading, bone grafting) variables on the early failure rate of second implants after replacement was evaluated. Due to the hierarchical structure of the data, a multivariate multilevel mixed-effects Poisson regression analysis was performed. Results: A total of 109 patients (63 men and 46 women) diagnosed with early implant failure at 124 implant sites were included in the present study. Fifty-eight implants were immediately replaced at the time of removal of the failed implant (test group), whereas 66 were replaced after a healing period of 2 to 4 months (delayed approach; control group). A total of 15 implants failed after replacement in 11 patients during the first 6 months of follow-up. Of these, nine failures (15.25%) occurred in seven patients (13.21%) after immediate replacement, and six (9.09%) occurred in four patients (7.02%) who underwent delayed replacement. No statistically significant differences were detected between the two groups (P = 0.431). Conclusions: No significant differences in implant survival at sites of previous failure were found according to the timing of implant replacement
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