The International Journal of Oral & Maxillofacial Implants, 6/2021
Online OnlyDOI: 10.11607/jomi.8987Pages e167-e173, Language: English
Purpose: The aim of this study was to evaluate suppuration on palpation, used as a diagnostic test, in the detection of peri-implantitis.
Materials and methods: A total of 65 patients with 267 implants were examined. Clinical inspection was performed by two blinded examiners: The first measured suppuration on palpation, and the second conducted a complete clinical examination. A third examiner combined the previously collected information with radiographic data and diagnosed the patients according to the European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification system. Calibration was conducted previously to the fourth examiner on a set of five patients not belonging to the study sample.
Results: When suppuration on palpation was associated with diagnosis of peri-implantitis, the specificity and negative predictive value were high (88% and 84%, respectively), meaning that an implant that was negative to suppuration on palpation had a high chance of not being affected by peri-implantitis. Conversely, the sensitivity and positive predictive value were low (45% and 54%), demonstrating that a suppurating implant will be affected by peri-implantitis in only half of the cases. Area under the curve was calculated as 60.4 (P = .012), and accuracy was found to be 78%.
Conclusion: Suppuration on palpation alone, as with any other clinical sign, does not allow a precise diagnosis of peri-implantitis. An implant without suppuration on palpation shows a high chance of being free of peri-implantitis, while an implant that suppurates upon palpation is not necessarily affected by peri-implantitis. Suppuration on palpation may be a valuable clinical sign, especially when evaluating implants that are difficult to examine via probing.
Keywords: bacteria, biologic complications, cross-sectional study, diagnostic procedure, peri-implantitis, suppuration
The International Journal of Prosthodontics, 5/2021
DOI: 10.11607/ijp.6718Pages 670-680, Language: English
The present clinical report describes a treatment strategy for transition from full-arch restorations supported either partially or fully by failing implants that need to be removed. More specifically, the staged approach proposes a deferred treatment sequence in which the failing implants or teeth are not all replaced simultaneously. With this technique, some failing natural or artificial abutments are preserved momentarily in order to maintain the patient with a fixed provisional restoration at all times throughout the execution of treatment, from the surgical phase until delivery of the final restoration. The present clinical report describes the staged approach in detail, compares it to other treatment options, and illustrates all phases of therapy with a clinical case.
The International Journal of Prosthodontics, 2/2021
Pages 145, Language: English
The International Journal of Oral & Maxillofacial Implants, 5/2020
DOI: 10.11607/jomi.8297, PubMed ID (PMID): 32991651Pages 995-1004, Language: English
Purpose: To describe the prevalence of alveolar bone atrophy in edentulous arches of elderly individuals in relation to insertion of dental implants and the eventual need for bone grafting procedures.
Materials and Methods: Computed tomography scan files of 228 edentulous arches of elderly patients (ages 65 to 100 years) were evaluated in relation to implant placement. Six measurements per arch were taken on cross-sectional reconstructions. Bone atrophy categories were described, in relation to implant placement, for the anterior and posterior sections of the arches. Six bone sections per arch were evaluated and allocated to the predetermined categories. Prevalence of each type of atrophy was calculated.
Results: In the maxilla, only 5.0% of the patients showed a bone anatomy capable of receiving implants without any augmentation both in the posterior and anterior regions; 64.4% showed the need for major reconstruction in both areas. In the mandible, 17.3% of the patients did not require any augmentation in both regions; 9.4% were in need of major reconstruction in both areas. The anterior part of the arches could eventually be treated without any bone augmentation in 10.9% of the maxillae and 72.4% of the mandibles, while minor augmentation was needed in 16.8% of maxillae and 15.8% of mandibles.
Conclusion: Most edentulous elderly patients show some degree of alveolar bone atrophy. It is often feasible to insert implants in the anterior mandible to support a restoration. In most maxillary cases, alveolar atrophy calls for augmentation procedures in both the anterior and posterior areas. In elderly individuals, the anterior maxilla often shows bone deficiency interfering with simple implant placement procedures, thus also limiting the use of tilted implants.
Keywords: bone atrophy, dental implants, edentulous arches, elderly population
The International Journal of Oral & Maxillofacial Implants, 5/2019
DOI: 10.11607/jomi.7465, PubMed ID (PMID): 31184632Pages 1143-1151, Language: English
Purpose: There is a lack of studies reporting long-term prevalence of peri-implant diseases in patients rehabilitated with overdentures and not receiving maintenance, which is a common situation. The aim of this cross-sectional study was to evaluate the patient satisfaction and rate of biologic complications in patients rehabilitated at least 7 years before with mandibular/maxillary overdentures, who for personal or economic reasons decided not to participate in a structured supportive maintenance program.
Materials and Methods: Each of the patients filled out a health and dental history and a visual analog scale (VAS)-based satisfaction questionnaire; additionally, the patients received a clinical examination and a panoramic radiograph. The prevalence of peri-implant diseases and the patient satisfaction were reported. Moreover, presumed risk indicators of peri-implant diseases and implant loss were tested through univariate analyses and multivariate, time-adjusted, logistic regressions.
Results: A total of 52 patients who received 63 overdentures on 252 implants were included. The included patients showed a high degree of satisfaction (mean VAS = 6.3; SD: 2.1) and very low discomfort rates and would repeat the type of rehabilitation (mean VAS = 6.99; SD: 2.6). The prevalence of peri-implantitis was 30.8% at patient level and 19.4% at implant level, while 23.1% of patients experienced implant loss at any time. A clear tendency toward increased prevalence of biologic complications after the eighth year of loading was noted. In loading time-adjusted regression analyses, bone-level implants were associated with a higher prevalence of recession with no/minimal inflammation (OR = 3.37; 95% CI: 1.16 to 9.77; P = .025), while the maxillary arch was associated with both severe peri-implantitis (OR = 4.18; 95% CI: 1.03 to 16.97; P = .046) and implant loss (OR = 9.27; 95% CI: 3.41 to 25.14; P = .000).
Conclusion: Despite high levels of satisfaction, patients rehabilitated with overdentures not participating in a structured supportive schedule show high rates of biologic complications. For this reason, they should be strongly motivated, at the time of prosthesis delivery, to participate in a structured maintenance program.
Keywords: long term, patient satisfaction, peri-implant diseases, peri-implantitis, peri-implant mucositis, risk factors, supportive
International Journal of Esthetic Dentistry, 3/2015
Pages 404-419, Language: German
Bei Rehabilitationen des gesamten Kiefers ist besonders die Phase der provisorischen Versorgung wichtig für die Bestimmung der korrekten individuellen Okklusion, Kieferrelation und Ästhetik des Patienten. Dabei ist es schwierig, diese Informationen auf die definitive Restauration zu übertragen. Es gibt bereits mehrere Techniken, mit denen die Informationen von festsitzenden zahnoder implantatgetragenen Provisorien auf definitive Restaurationen übertragen werden können. Im vorliegenden Beitrag wird der Vorschlag der Autoren für eine Technik beschrieben, mit deren Hilfe Informationen von herausnehmbaren Prothesen auf implantatgetragenen Zahnersatz übertragen werden können.
International Journal of Esthetic Dentistry (EN), 3/2015
PubMed ID (PMID): 26171445Pages 428-443, Language: English
When dealing with full-arch rehabilitation, the provisional phase is important in order to define the correct occlusal, intermaxillary, and esthetic relationships for each individual patient. In these cases, it is difficult to transfer this information to the final restorations. Several techniques have been developed to transfer the information from tooth- or implant-supported fixed provisionals to the definitive rehabilitations. The present article describes a technique proposed by the authors to transfer the information from a removable prosthesis to an implant-supported restoration.
Quintessence International, 5/2014
DOI: 10.3290/j.qi.a31534, PubMed ID (PMID): 24634906Pages 419-429, Language: English
Objective: The rehabilitation of edentulous mandibles with implant-supported overdentures is a state-of-the-art contemporary implant treatment. Computer-assisted flapless surgery is associated with decreased chairside treatment time, as well as significant reduction in patient postoperative morbidity and discomfort. The aim of this study was to evaluate the protocol of computer-guided surgery in the treatment of edentulous mandibles with overdentures supported by four intraforaminal implants and retained by Locator® attachments in elderly patients, both from a clinician's and a patient's perspective, as well as to assess the stability of the results in a 2-year period.
Method and Materials: 15 patients presenting edentulous mandibles and discomfort while wearing conventional overdentures were enrolled in the study. Careful presurgical and computer-assisted 3D treatment planning was performed. Patients were treated with four intraforaminal implants using a computer-assisted flapless approach. All patients were prosthetically rehabilitated with overdentures. Clinical parameters such as peri-implant probing depth (PPD), Plaque Index (PI), and bleeding on probing (BOP) were evaluated. Patients' perceptions regarding the outcome were assessed on visual analog scales (VAS).
Results: Out of 15 patients consecutively included in the study, only 10 patients could be treated with the designed protocol. A total of 40 Camlog implants were placed. No implant was lost over a 2-year period. BOP was negative in 82% of sites; mean PPD was 2.34 mm; 8 of the 40 implants showed the absence of keratinized tissue on the lingual or the vestibular aspect. The VAS score of 9.9 demonstrated the satisfaction of the patients.
Conclusions: Within the limitations of this study, the data demonstrate that in a significant number of cases this protocol could not be used for anatomical or technical reasons. In the cases where it could be used, the computer-assisted protocol appeared suitable for treating elderly patients with mandibular edentulism and restoring them with an overdenture in a minimally invasive way. The possibility of placing implants outside the borders of the keratinized tissue is relevant.
Keywords: flapless surgery, guided surgery, overdenture
Quintessence International, 1/2013
DOI: 10.3290/j.qi.a28745, PubMed ID (PMID): 23444160Pages 37-43, Language: English
The edentulous maxilla is often affected by bone resorption, sometimes making it difficult to place standard diameter implants. Narrow diameter implants made of titanium-zirconium (Ti-Zr) alloy, which has superior mechanical properties compared with titanium, have been proposed for these difficult situations. This retrospective clinical observation reports the outcome of the use of reduced diameter implants made of Ti-Zr alloy supporting maxillary overdentures retained with locator abutments. The charts of all patients who received maxillary overdentures supported by four unsplinted implants from January 2009 to June 2010 at the Department of Periodontology and Prosthodontics, Eastman Dental Hospital, Rome, Italy, were reviewed. All patients treated with four narrow diameter Ti-Zr implants were selected for the present case series. Ten patients were found, six of whom received augmentation procedures. After 12 to 16 months of follow-up, no implants were lost, and only one implant showed bone resorption greater than 1.5 mm. Implants showed a success rate of 97.5% and a survival rate of 100%. All prostheses were successfully in function. The present case series showed promising results regarding the use of narrow diameter implants made of Ti-Zr supporting maxillary overdentures retained with locator abutments.
Keywords: edentulous maxilla, narrow implants, overdenture, titanium-zirconium
International Journal of Periodontics & Restorative Dentistry, 1/2012
Online OnlyPubMed ID (PMID): 22254230Pages 59, Language: English
The aim of this study was to evaluate whether the use of enamel matrix derivative (EMD) improves clinical results of the coronally advanced flap (CAF) procedure in the treatment of multiple gingival recession defects. Ten patients presenting at least two adjacent buccal gingival recession defects affecting symmetric teeth on both sides of the maxilla were included in this study. Each set of multiple recession defects was assigned randomly to the test or control group. A bilateral simultaneous CAF procedure with vertical releasing incisions, with the adjunct of EMD for test sites, was performed. Clinical measurements (recession length, keratinized tissue, probing depth, and clinical attachment level) were assessed at baseline and 6 and 24 months after surgery by a blinded examiner. At the 6-month evaluation, both treatment procedures displayed good results with significant root coverage gain (CAF, 80.7% ± 20%; CAF + EMD, 82.8% ± 14%). A similar amount of relapse was noted at the 24-month evaluation when compared with the 6-month results (CAF, 71.0% ± 22%; CAF + EMD, 74.8% ± 16%). The use of EMD does not seem to significantly improve the results of the CAF procedure for root coverage in treatment of multiple recessions.