Techniques on vertical ridge augmentation: Indications and effectiveness.

Vertical ridge augmentation techniques have been advocated to enable restoring function and esthetics by means of implant-supported rehabilitation. There are three major modalities. The first is guided bone regeneration, based on the principle of compartmentalization by means of using a barrier membrane, which has been demonstrated to be technically demanding with regard to soft tissue management. This requisite is also applicable in the case of the second modality of bone block grafts. Nonetheless, space creation and maintenance are provided by the solid nature of the graft. The third modality of distraction osteogenesis is also a valid and faster approach. Nonetheless, owing to this technique's inherent shortcomings, this method is currently deprecated. The purpose of this review is to shed light on the state-of-the-art of the different modalities described for vertical ridge augmentation, including the indications, the step-by-step approach, and the effectiveness

Resolution of peri‐implantitis by means of implantoplasty as adjunct to surgical therapy: A retrospective study

BackgroundThere is a paucity of data on the effectiveness of implantoplasty as adjunct to the surgical management of peri- implantitis. The purpose of this study was to evaluate the resolution of peri- implantitis by means of implantoplasty as adjunct to surgical resective (RES) and reconstructive (REC) therapies and supportive maintenance.MethodsPatients that underwent surgical therapy to manage peri- implantitis with a follow- up of - ¥12 months and enrolled in a regular peri- implant supportive care were recruited. RES group consisted of two interventions that included osseous recontouring and apically position flap (APF) and soft tissue conditioning (STC). REC was performed in the infra- osseous compartment of combined defects. Implant survival rate was recorded. Clinical and radiographic parameters were evaluated to define a - dogmatic- (case definition #1) and a - flexible- (case definition #2) therapeutic success. Univariate and multivariate multilevel backward logistic regression were applied for statistical analysis.ResultsOverall, 43 patients (nimplants = 135) were retrospectively assessed. Mean observational period was - ¼24 months. Implant survival rate was 97.8%, being significantly higher for APF, STC, and APF + STC (RES) when compared with REC (P = 0.01) therapy, in particular for advanced lesions (>50% of bone loss). The overall therapeutic success rate at implant- level was 66% and 79.5% for case definition #1 and #2, respectively. APF group displayed more efficient disease resolution when considered success definition #1 (72%). Contrarily, when the data were adhered to success definition #2, STC group showed a slightly higher disease resolution rate (87%). For RES group, location, favoring anterior (P = 0.04) and defect type, favoring class II (P = 0.02) displayed statistical significance for therapeutic success. For REC group, implants exhibiting a wider band of keratinized mucosa (KM) demonstrated higher therapeutic success (P = 0.008).ConclusionImplantoplasty as an adjunct to surgical therapy proved effective in terms of disease resolution and implant survival rate. Implant location, defect morphology as well as the buccal width of KM are indicators of therapeutic success.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/171570/1/jper10772.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/171570/2/jper10772_am.pd

Resolution of peri- implantitis by means of implantoplasty as adjunct to surgical therapy: A retrospective study

BackgroundThere is a paucity of data on the effectiveness of implantoplasty as adjunct to the surgical management of peri- implantitis. The purpose of this study was to evaluate the resolution of peri- implantitis by means of implantoplasty as adjunct to surgical resective (RES) and reconstructive (REC) therapies and supportive maintenance.MethodsPatients that underwent surgical therapy to manage peri- implantitis with a follow- up of - ¥12 months and enrolled in a regular peri- implant supportive care were recruited. RES group consisted of two interventions that included osseous recontouring and apically position flap (APF) and soft tissue conditioning (STC). REC was performed in the infra- osseous compartment of combined defects. Implant survival rate was recorded. Clinical and radiographic parameters were evaluated to define a - dogmatic- (case definition #1) and a - flexible- (case definition #2) therapeutic success. Univariate and multivariate multilevel backward logistic regression were applied for statistical analysis.ResultsOverall, 43 patients (nimplants = 135) were retrospectively assessed. Mean observational period was - ¼24 months. Implant survival rate was 97.8%, being significantly higher for APF, STC, and APF + STC (RES) when compared with REC (P = 0.01) therapy, in particular for advanced lesions (>50% of bone loss). The overall therapeutic success rate at implant- level was 66% and 79.5% for case definition #1 and #2, respectively. APF group displayed more efficient disease resolution when considered success definition #1 (72%). Contrarily, when the data were adhered to success definition #2, STC group showed a slightly higher disease resolution rate (87%). For RES group, location, favoring anterior (P = 0.04) and defect type, favoring class II (P = 0.02) displayed statistical significance for therapeutic success. For REC group, implants exhibiting a wider band of keratinized mucosa (KM) demonstrated higher therapeutic success (P = 0.008).ConclusionImplantoplasty as an adjunct to surgical therapy proved effective in terms of disease resolution and implant survival rate. Implant location, defect morphology as well as the buccal width of KM are indicators of therapeutic success.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/171570/1/jper10772.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/171570/2/jper10772_am.pd

Dimensional changes in free epithelialized gingival/mucosal grafts at tooth and implant sites: A prospective cohort study

BackgroundA study was made of the dimensional changes in free epithelialized gingival/mucosal grafts (FEGs) used to augment keratinized tissue (KT) at tooth and implant sites, and of the confounders influencing the dynamic changes over 6 months of follow-up.MethodsA prospective cohort interventional study was made of implant and tooth sites needing KT augmentation by means of an apically positioned flap and FEG. Six intraoperative variables were recorded at baseline (T0). In addition, graft width (GW), graft length (GL), and graft dimension (GD) were assessed at 3 weeks (T1), 3 months (T2), and 6 months of follow-up (T3). Univariate and multivariate analyses were performed to explore associations between the demographic and intraoperative variables and the outcomes over the study period.ResultsBased upon an a priori power sample size calculation, a total of 56 consecutive patients were recruited, of which 52 were available for assessment. A total of 73 graft units were included in 122 sites. At T3, the mean change in GD in FEG was 40.21%. In particular, the mean changes in GL and GW were 12.13% and 33.06%, respectively. Statistically significant changes in GD were recorded from T0 to T1 (P < 0.0005) and from T1 to T2 (P < 0.0005), but not from T2 to T3 (P = 0.13). The change in GD at T3 was 33.26% at tooth and 43.11% at implant site level (P = 0.01). Age and GW assessed at T0 proved to be related to the changes in GD and GW in the univariate and multivariate analyses. The univariate analysis showed the avascular area (AA) to be related to the changes in GD and GW at the implant sites, whereas graft thickness (GT) was associated to changes in GD and GW at the tooth sites in the univariate and multivariate analyses.ConclusionFree epithelialized grafts are exposed to dimensional changes that result in a reduction of approximately 40% of the original graft dimension–the changes being approximately 10% greater at the implant sites than at the tooth sites (NCT04410614).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/173126/1/jper10920_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/173126/2/jper10920.pd

Hard tissue dimensional changes following implant removal due to peri- implantitis: A retrospective study

BackgroundThe current evidence regarding the alterations experienced by the alveolar ridge (hard tissue changes) after implant removal due to peri- implantitis is limited.PurposeTo assess the hard tissue dimensional changes following implant removal due to peri- implantitis.Material and methodsClinical records were examined to identify patients with implants that had to be removed due to a hopeless prognosis secondary to peri- implantitis due to expendability of peri- implantitis implants for functional reasons. Patients with preoperative and postoperative cone- beam computed tomography (CBCT) scans were included. Patient- related, implant- related, and surgery- related factors were assessed based on the clinical records. Linear measurements were made to evaluate the influence of bone plate thickness (BPT), ridge width (RW), and ridge height (RH) at various levels upon the outcome of implant removal. A descriptive statistical analysis of the quantitative and qualitative variables was performed. Correlations of the variables with the primary outcome (dimensional changes) were tested using univariate and multivariate analyses (multinomial random intercept mixed model linear regressions).ResultsA total of 26 patients (nimplants =- 79) met the eligibility criteria. The mean decrease in RW at 1 and 3- mm below the crest was 11.3% and 4.4%, respectively (P <- 0.001). Buccal and lingual RH was significantly reduced by 2.2% and 6.3%, respectively (P <- 0.001). Few patient- related, implant- related, and surgery- related factors appeared to have an impact upon the hard tissue dimensional changes. Bone regeneration simultaneous to implant removal minimized the dimensional changes of the ridge both vertically (5% lesser buccal RH reduction) and horizontally (12% lesser RW reduction) when compared with spontaneous healing. The use of a reverse- torque removal kit seemed to be critical in limiting the dimensional changes of the ridge.ConclusionsMinimal hard tissue changes can be expected following implant removal due to peri- implantitis. Simultaneous bone regeneration procedures and the use of a removal kit may considerably reduce the impact upon the dimensional changes (NCT04534361).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168329/1/cid13004.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168329/2/cid13004_am.pd

Influence of the Level of Compliance with Preventive Maintenance Therapy upon the Prevalence of Peri-Implant Diseases: A cross-sectional study.

BACKGROUND A study was made to evaluate peri-implant conditions in compliers and erratic compliers with peri-implant maintenance therapy (PIMT), and to assess the role of site-specific confounders. METHODS Erratic PIMT compliers (EC) were defined as presenting attendance < 2x/year, while regular compliers (RC) attended ≥ 2x/year. Generalized estimating equations (GEE) were employed to perform a multivariable multilevel analysis in which the peri-implant condition was established as dependent variable. RESULTS Overall, 86 non-smoker patients (42 RC and 44 EC) attending the department of periodontology of the Universitat Internacional de Catalunya were recruited consecutively on a cross-sectional basis. The mean period of loading was 9.5y. An implant placed in an erratic patient has 88% higher probability of presenting peri-implant diseases versus RC. Furthermore, the probability of diagnosis of peri-implantitis was significantly higher in EC vs RC (OR 5.26; 95% CI: 1.51 - 18.29) (p = 0.009). Among other factors, history of periodontitis, non-hygienic prosthesis, period of implant loading and Modified Plaque Index (MPI) at implant level were shown to significantly increase the risk of peri-implantitis diagnosis. Although not associated with peri-implantitis diagnosis risk, keratinized mucosa (KM) width and vestibular depth (VD) were significantly associated to plaque accumulation (mPI). CONCLUSIONS Compliance with PIMT was found to be significantly associated with peri-implant status. In this sense, attending PIMT < 2x/year may not be sufficient to prevent peri-implantitis. These outcomes should be limited to a non-smokers population. This article is protected by copyright. All rights reserved

Significance of probing for monitoring peri-implant diseases.

Peri-implant diseases at implant sites represent the most considerable concern for many dental clinicians nowadays due to their detrimental effect on implant longevity. Preventive measures include patient education and motivation, supportive peri-implant therapy and routine assessment of the hard and soft tissues. Nevertheless, the reliability of clinical parameters to monitor peri-implant conditions is subject to debate. As such, the primary purpose of the present review was to gain further insight into the diagnostic accuracy of probing as a clinical tool to monitor dental implants and assist clinicians in preventing peri-implant diseases. Studies have recommended periodic probing to monitor the condition of the peri-implant tissues. Increased probing pocket depth, profuse bleeding on probing and suppuration at implants are clinical signs that have been associated with peri-implantitis; thus, if these clinical parameters are present, radiographic assessment is encouraged to make a definitive diagnosis considering potential inaccuracies related to local and/or systemic factors identified in the present review

Strategies for implant surface decontamination in peri-implantitis therapy.

Peri-implantitis is an infectious disease that leads to progressive bone loss. Surgical therapy has been advocated as a way of halting its progression and re-establishing peri-implant health. One of the most challenging but crucial tasks in the management of peri-implantitis is biofilm removal to achieve reosseointegration and promote the reduction of peri-implant pockets. A wide variety of strategies have been used for implant surface decontamination. Mechanical means have been demonstrated to be effective in eliminating calculus deposits and residual debris; however, the presence of undercuts and the grooves and porosities along the roughened implant surface make it difficult to achieve an aseptic surface. In conjunction with mechanical measures, use of chemical adjuncts has been advocated to dilute bacterial concentrations, destroy the bacteria's organic components and eliminate endotoxins. Pharmacological adjuncts have also been recommended to diminish the bacterial load. Other strategies, such as use of lasers, implantoplasty and electrolysis, have been suggested for implant surface decontamination to promote predictable clinical and radiographic outcomes