Implant Prophylaxis: The Next Best Practice Toward Asepsis in Spine Surgery.

Study designA literature review.ObjectivesAn evaluation of the contaminants prevalent on implants used for surgery and the aseptic methods being employed against them.MethodsPubMed was searched for articles published between 2000 and 2017 for studies evaluating the contaminants present on spine implants, and associated pre- and intraoperative implant processing and handling methodology suggested to avoid them. Systematic reviews, observational studies, bench-top studies, and expert opinions were included.ResultsEleven studies were identified whose major focus was the asepsis of implants to reduce the incidence of surgical site infection incidences during surgery. These studies measured the colony forming units of bacteria on sterilized implants and/or gloves from the surgeon, scrub nurse, and assistants, as well as reductions of surgical site infection rates in spine surgery due to changes in implant handling techniques. Additionally, the search included assessments of endotoxins and carbohydrates present on reprocessed implants. The suggested changes to surgical practice based on these studies included handling implants with only fresh gloves, keeping implants covered until the immediate time of use, reducing operating room traffic, avoiding reprocessing of implants (ie, providing terminally sterilized implants), and avoiding touching the implants altogether.ConclusionsBoth reprocessing (preoperative) and handling (intraoperative) of implants seem to lead to contamination of sterilized implants. Using a terminally sterilized device may mitigate reprocessing (preoperative implant prophylaxis), whereas the use of fresh gloves for handling each implant and/or a permanent shielding technique (intraoperative implant prophylaxis) could potentially avoid recontamination at the theatre

Carbon offers advantages as implant material in human body

Because of such characteristics as high strength and long-term biocompatability, aerospace carbonaceous materials may be used as surgical implants to correct pathological conditions in the body resulting from disease or injury. Examples of possible medical uses include bone replacement, implantation splints and circulatory bypass implants

Unified Approach to the Biomechanics of Dental Implantology

The human need for safe and effective dental implants is well-recognized. Although many implant designs have been tested and are in use today, a large number have resulted in clinical failure. These failures appear to be due to biomechanical effects, as well as biocompatibility and surgical factors. A unified approach is proposed using multidisciplinary systems technology, for the study of the biomechanical interactions between dental implants and host tissues. The approach progresses from biomechanical modeling and analysis, supported by experimental investigations, through implant design development, clinical verification, and education of the dental practitioner. The result of the biomechanical modeling, analysis, and experimental phases would be the development of scientific design criteria for implants. Implant designs meeting these criteria would be generated, fabricated, and tested in animals. After design acceptance, these implants would be tested in humans, using efficient and safe surgical and restorative procedures. Finally, educational media and instructional courses would be developed for training dental practitioners in the use of the resulting implants

3D-printing techniques in a medical setting : a systematic literature review

Background: Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. Methods: Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. Results: 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. Conclusion: 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D- printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis

Use of long implants with distal anchorage in the skull base for treatment of extreme maxillary atrophy : the remote bone anchorage concept

The objectives of this study are to present a new concept of the bone anchorage using long implants in remote bone sites and to discuss four cases treated with this method. Our patients were treated with long implants with a distant anchorage in the skull bone. The planning procedure, the construction of the drill guide, and the surgical protocol are described. In the clinical cases described, all four patients were rehabilitated with the remote bone anchorage concept using long implants anchored in the skull base. Patients were followed for 5 - 12 years and the implants remained present and stable in these time periods. The skull base implant is a new concept of bone anchorage using long implants. It can be a solution for complicated clinical situations (often failed bone reconstructions and implant placements) or an alternative for bone grafting and maxillary augmentation procedures. There is effective implant retention in the skull base, an anatomical area that is often overlooked for implant placement

Implant survival and success rates in patients with risk factors: results from a long-term retrospective study with a 10 to 18 years follow-up

OBJECTIVE: Risk factors for implant therapy are represented by all general and local conditions that through various mechanisms can increase either short-term and long-term failure risk. The aim of this study is to assess the implant survival and implant success rates with single and multiple risk factors. PATIENTS AND METHODS: To address the research purpose, a retrospective cohort study was designed and implemented, including a sample of 225 patients with a total of 871 implants placed. The following risk factors were considered: smoking, bruxism, bone augmentation procedures and the presence of load risk (implants with crown/implant relation > 0.8; angulation > 25°; presence of cantilever). Follow-up ranged from 10 years to 18 years (average follow-up 13.6 years). Failures were subdivided into short-term failures, before the prosthetic phase, and long-term failures, after definitive prosthesis. The success criteria published by Albrektsson and Zarb were adopted. A Cox proportional hazard regression model was used to calculate hazard ratio, with a statistically significant p-value <0.05. RESULTS: Out of the 871 implants placed, 138 did not meet the success criteria, (success rate 84.16%), sixty (43.47%) were classified as "early failure" and seventy-eight as "late failure" (56.53%). A total of 70 dental implants were removed, with a survival rate of 91.96%. CONCLUSIONS: The presence of a single risk factor does not imply a marked increase of failure risk. Among the analyzed factors, the one that proved to be the most dangerous was bruxism, even when presented as the only risk factor. Bruxism with load risk proved to be the most dangerous association (success rate 69.23%) and could be included among the absolute contraindications for implant treatment

Orthodontic palatal implants: clinical technique

The aim of this paper is to familiarize the readers with some of the clinical considerations necessary to ensure successful use of mid-palatal implants. Both surgical and technical aspects will be discussed along with a description of impression techniques used

Gingival hyperplasia around dental implants in jaws reconstructed with free vascularized flaps: a case report series

Free vascularized flaps are the gold standard for reconstruction of the facial skeleton after surgical ablation of pathologies or when important atrophy of the jaws exists. A frequent problem seen during prosthetic rehabilitation after reconstruction with free vascularized flaps is the onset of hyperplastic granulomatous reactive tissue around the prosthetic abutment of the implant. The features of this phenomenon seem to be directly related to the characteristics of the periimplant tissue and of the manufacturing materials of the prosthesis and abutments. This complication can be seen quite often; we found it in 7 of 40 patients (17.5%). It does not seem to significantly affect the survival rate of implants. The aim of the study was to analyze the behavior of such lesions and to suggest our clinical approach with the management of these kinds of patients and complications. To remove gingival hyperplasia, we used either a traditional cold scalpel or an electric cautery or laser. We had good results using these tools. The onset of this phenomenon was not influenced by either the kind of implant and free flaps used or by the local conditions of the patients (such as radiotherapy). The number of recurrences was highly influenced by the oral hygiene of the patients

"All on short" prosthetic-implant supported rehabilitations

Objectives. Short implants are increasing their popularity among clinicians who want to fulfill the constant demanding of fixed prosthetic solutions in edentulous jaws. The aim of this report was to propose a new possibility to project and realize an occlusal guided implant cross-arch prosthesis supported by ultra-short implants, describing it presented an edentulous mandible case report. Methods. A 61-year-old, Caucasian, female patient who attended the dental clinic of the University of L’Aquila presented with edentulous posterior inferior jaw and periodontitis and periimplantitis processes in the anterior mandible. The remaining tooth and the affected implant were removed. Six 4-mm-long implants were placed to support a cross-arch metal-resin prosthesis. Results. At 1-year follow-up clinical and radiological assessment showed a good osseointegration of the fixtures and the patient was satisfied with the prosthesis solution. Conclusion. The method, even if it requires further validation, seems to be a valid aid in solving lower edentulous clinical cases, and appears less complex and with more indications of other proposals presented in the current clinical literature. Our case report differs from the current technique All-on-Four, which uses four implants in the mandible to support overdenture prosthesis, assuring a very promising clinical resul

Optimizing Anterior Implant Outcome Immediately After Implant Placement and Grafting by Using Patient’s Extracted Teeth: A Case Report

Optimizing anterior implant outcome using patient’s extracted teeth. Successful implant treatment in the anterior maxilla is predicated on providing a functional and esthetically acceptable outcome. As well, achieving a predictable ideal emergence profile and soft tissue contour is expected. Placing immediate provisional restorations utilizing the patient’s modified extracted teeth can facilitate initiate facial soft tissue contouring while precluding undue pressure on the surgical site during the early healing phase. This allows for a one stage surgical procedure, fixed provisionalization and ideal tissue contouring. This clinical report presents the use of a patient’s modified extracted permanent teeth as bonded fixed provisional restorations placed immediately after implant placement and bone grafting. The gingival-lingual and cingulum tooth structure was recontoured to allow no contact with the implant or bone graft material. A combination of cement and screw-retained definitive restorations were fabricated with contours reflecting the tissue contours established by the interim restoration