Does Apico-Coronal Implant Position Influence Peri-Implant Marginal Bone Loss? A 36-Month Follow-Up Randomized Clinical Trial

Purpose: Preserving peri-implant bone and reducing exposure of the rough implant surface might influence long-term outcomes of implant therapy. The aim of this study was to compare peri-implant clinical and radiologic parameters after crestal and subcrestal dental implant placement at 36 months’ follow-up. Materials and Methods: We carried out a randomized clinical trial involving partially edentulous patients in need of an implant-supported, partial fixed dental prosthesis or a single crown. Patients were randomized according to the implant insertion depth: implants placed approximately 2 mm below the bone crest (test group) or implants placed at bone crest level (control group). They were evaluated 6, 12, 24, and 36 months after prosthetic loading. Peri-implant marginal bone loss was the primary outcome, and the following secondary outcomes were registered: coronal bone changes, plaque index, probing depth, modified bleeding index, retraction and width of the peri-implant mucosa, and peri-implant health condition. Implant survival and success rates after 36 months’ follow-up were calculated. Results: The study comprised 128 patients (83 men and 45 women; mean age, 54.4 ± 12.2 years) and a total of 265 implants (133 in control group and 132 in test group). No statistically significant differences in the peri-implant clinical parameters were found. After 3 years’ follow-up, 53.4% of the crestal implants and 25.8% of the subcrestal implants presented marginal bone loss, with a mean exposed rough surface of –0.2 ± 0.3 mm and –0.09 ± 0.1 mm, respectively (P =.001). The overall success rate was 99.6%. Conclusions: Crestal and subcrestal implants showed similar clinical outcomes 3 years after prosthetic loading. Significant differences were observed in the radiologic parameters, showing less peri-implant marginal bone loss with subcrestal implants

Implant treatment in atrophic posterior mandibles: Vertical regeneration with block bone grafts versus implants with 5.5-mm intrabony length

Purpose: To retrospectively compare the outcomes of implants placed in posterior mandibles vertically regenerated with onlay autogenous block bone grafts and short dental implants. Materials and Methods: Consecutive patients with vertical bone atrophy in edentulous mandibular posterior regions (7 to 8 mm of bone above the inferior alveolar nerve) were treated with either implants placed in regenerated bone using autologous block bone grafts (group 1) or short implants (with 5.5-mm intrabony length) in native bone (group 2) between 2005 and 2010 and followed for 12 months after loading. The procedure used was the established treatment protocol for this type of patient at the Oral Surgery Unit (University of Valencia, Spain) at the time of surgery. All grafts were obtained using piezosurgery. The outcomes assessed were: complications related to the procedure, implant survival, implant success, and peri-implant marginal bone loss. Statistical analysis was done using the Fisher exact test and the Mann-Whitney test. Results: Thirtyseven patients were included, 20 (45 implants) in group 1 and 17 (35 implants) in group 2. In group 1, 13 implants were less than 10 mm long (2 were 7 mm and 11 were 8.5 mm), and 32 were 10 mm or longer; the diameter was 3.6 mm in 6 implants, 4.2 mm in 31, and 5.5 mm in 8. In group 2 all implants were 7 mm long; the diameter measured 4.2 mm in 14 implants and 5.5 mm in 21 implants. Complications related to the block bone grafting procedure were temporary hypoesthesia in one patient, wound dehiscence with graft exposure in three patients, and exposure of the osteosynthesis screw without bone graft exposure in one patient. After 12 months, implant survival rates were 95.6% in group 1 and 97.1 % in group 2; success rates were 91.1% and 97.1%, respectively. The average marginal bone loss was 0.7 ± 1.1 mm in group 1 and 0.6 ± 0.3 mm in group 2. Conclusions: When residual bone height over the mandibular canal is between 7 and 8 mm, short implants (with 5.5-mm intrabony length) might be a preferable treatment option over vertical augmentation, reducing chair time, expense, and morbidity

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways