Immediate bleeding complications in dental implants: a systematic review

Objective: A review is made of the immediate or immediate postoperative bleeding complications in dental implants, with a view to identifying the areas of greatest bleeding risk, the causes of bleeding, the length of the implants associated with bleeding, the most frequently implicated blood vessels, and the treatments used to resolve these complications. Material and Methods: A Medline (PubMed) and Embase search was made of articles on immediate bleeding complications in dental implants published in English up until May 2014. Inclusion criteria: studies in humans subjects with severe bleeding immediately secondary to implant placement, which reported the time until the hemorrhage, the implant lenght, the possible cause of bleeding and the treatment. Exclusion criteria: patients receiving anticoagulation treatment. Results: Fifteen articles met the inclusion criteria. The area with the largest number of bleeding complications corresponded to the mandibular canine. The cause of bleeding was lingual cortical bone perforation during implant placement, with damage to the sublingual artery. The implants associated with bleeding were those measuring 15 mm in length or more. Management focused on securing the airway (with intubation or tracheostomy if necessary), with bleeding control. Conclusions: It’s important to pay special attention when the implants are placed in the mandibular anterior zone, especially if long implants are used. The most frequently cause of bleeding was the perforation of the lingual plate. Treatment involves securing the airway, with bleeding contro

Implantes cortos en la rehabilitación de pacientes desdentados posteriores con crestas atróficas. Estudio de casos-controles con seguimiento de 1 hasta 5 años

Los implantes dentales suelen ser el tratamiento de elección para las ausencias dentales. Sin embargo, la disponibilidad ósea en los sectores posteriores maxilares y mandibulares se ve comprometida frecuentemente por la presencia de estructuras anatómicas importantes como el nervio alveolar inferior o el seno maxilar. Los implantes cortos son una alternativa de tratamiento, pero se ha planteado que su reducida longitud puede comprometer el éxito del tratamiento. Los objetivos de esta tesis son analizar el éxito y la pérdida ósea de los implantes cortos y analizar los factores de riesgo. Material y método: se incluyeron 177 pacientes con 435 implantes de 8,5 mm de longitud (7 mm intraóseos) en el grupo de implantes cortos y de más de 11,5 mm de longitud en el grupo de implantes convencionales, tras cumplir los criterios de inclusión y exclusión. Todos los implantes fueron colocados en sectores posteriores, rehabilitados con prótesis de hasta un máximo de tres coronas sin pónticos. Los tiempos de seguimiento variaron entre 12 y 60 meses, analizando como variables principales el éxito de los implantes (cada año) y la pérdida ósea marginal periimplantaria (a los 12 meses). Para catalogar el éxito de los implantes se siguieron los criterios de éxito de Buser (1990) y para la pérdida ósea marginal periimplantaria se utilizaron radiografías periapicales paralelizadas tomadas en el momento de la carga y a los 12 meses de carga protésica. Además se analizaron una lista de posibles factores de confusión: edad, sexo, consumo de tabaco, higiene oral, cirujano, posición del implante, altura de hueso remanente, longitud, diámetro, uso de osteodilatadores, fases de la cirugía, tipo de hueso, tipo de ferulización protésica, antagonista y la proporción corona-implante. La potencia estadística del estudio fue de 0,94 para N = 435 implantes. Para el análisis estadístico de los datos se utilizaron modelos de regresión logística generalizados para analizar el éxito ajustando por factores de confusión y modelos lineales generalizados para el análisis de la pérdida ósea marginal periimplantaria ajustando por factores de confusión. En las variables que no se pudieron incluir en el modelo se realizaron análisis bivariante (t-Student, U de Mann-Whitney, ANOVA, χ2). El nivel de significatividad fue de α = 0,05. Resultados: no se encontraron diferencias estadísticamente significativas para el éxito (p = 0,173) ni la pérdida ósea marginal periimplantaria, aunque se encontró una tendencia a una mayor pérdida ósea en los implantes cortos (p = 0,059). El único factor de confusión que mostró diferencias estadísticamente significativas fue el tipo de antagonista (p = 0,023) pero únicamente cuando sólo se analizaban los implantes cortos. En este caso la pérdida ósea marginal fue 0,27 mm inferior cuando el antagonista era dentición natural. Conclusiones: El éxito global de los implantes cortos a los 5 años fue del 97,4%. Los implantes cortos no presentaron diferencias estadísticamente significativas en el éxito respecto a los implantes de longitud convencional, con un seguimiento de hasta 5 años. A los 12 meses, la pérdida ósea marginal en los implantes cortos fue de 0,79 mm y 0,65 mm en los de longitud convencional. Las diferencias no fueron estadísticamente significativas. El éxito de los implantes cortos frente a los convencionales fue similar independientemente de si los implantes se encontraban ferulizados o no. Se obtuvieron estos mismos resultados para la pérdida ósea marginal. Los factores de riesgo estudiados: edad, sexo, consumo de tabaco, higiene, antagonista, altura ósea remanente, cirujano, dilatadores, longitud, diámetro, osteodilatadores, cirugía en 1 o 2 fases, tipo de hueso, tipo de prótesis, tipo de ferulización, antagonista y la proporción corona implante, no influyeron en el éxito y la pérdida ósea marginal periimplantaria

Implantes inmediatos a la exodoncia: situación actual

Los implantes inmediatos son insertados en el mismo acto quirúrgico en el cual se extrae el diente a sustituir. Su porcentaje de éxito varía según diferentes autores entre un 92,7 % y 98,0 %. Su principal indicación es la sustitución de dientes con patologías sin posibilidad de tratamiento. Entre sus ventajas, respecto a los implantes diferidos, están el disminuir la reabsorción ósea del alvéolo post-extracción, el acortar el tiempo de tratamiento rehabilitador y evitar una segunda cirugía de implantación. Como inconvenientes están el requerir, generalmente, técnicas de regeneración ósea guiada con membranas, con el riesgo de exposición e infección de la misma; y la necesidad de injertos mucogingivales para el cierre del alvéolo y/o cubrir las membranas. Los requisitos quirúrgicos incluyen una exodoncia con el menor trauma posible, respetar las paredes alveolares y un curetaje alveolar minucioso que elimine todo tejido patológico. La estabilidad primaria es un requisito fundamental, se obtiene con una implantación que sobrepase en 3-5 mm el ápice alveolar o un implante de mayor diámetro que el alvéolo remanente. Una emergencia estética, en la zona anterior, se consigue insertando el implante subcrestalmente entre 1-3 mm. Respecto a la regeneración ósea guiada del alvéolo, no existe un consenso entre los diferentes autores en cuanto a la utilización de membranas y el tipo de material de relleno. El cierre primario de la herida es algo deseable aunque para algunos autores no tiene gran relevancia.Immediate implants are positioned in the course of surgical extraction of the tooth to be replaced. The percentage success of such procedures varies among authors from 92.7-98.0%. The main indication of immediate implantation is the replacement of teeth with pathologies not amenable to treatment. Its advantages with respect to delayed implantation include reduced post-extraction alveolar bone resorption, a shortening of the rehabilitation treatment time, and the avoidance of a second surgical intervention. The inconveniences in turn comprise a general requirement for membrane-guided bone regeneration techniques, with the associated risk of exposure and infection, and the need for mucogingival grafts to seal the socket space and/or cover the membranes. The surgical requirements for immediate implantation include extraction with the least trauma possible, preservation of the extraction socket walls and thorough alveolar curettage to eliminate all pathological material. Primary stability is an essential requirement, and is achieved with an implant exceeding the alveolar apex by 3-5 mm, or by placing an implant of greater diameter than the remnant alveolus. Esthetic emergence in the anterior zone is achieved by 1-3 mm sub-crest implantation. Regarding guided regeneration of the alveolar bone, the literature lacks consensus on the use of membranes and the type of filler material required. While primary wound closure is desirable, some authors do not consider it to be of great relevance

Fibroma cemento-osificante mandibular: presentación de dos casos y revisión de la literatura

Presentamos dos casos clínicos de lesiones radiotransparentes mandibulares en mujeres jóvenes, que simularon patología infecciosa crónica periapical. En ambos el hallazgo fue casual puesto que no produjeron ningún tipo de sintomatología. En un caso se llegó al diagnóstico (tras la cirugía periapical y el estudio anatomo-patológico) después de realizar la endodoncia del diente implicado y comprobar la no resolución del área periapical. En el otro caso, cuya lesión abarcaba el periápice de los 4 incisivos inferiores, se realizó directamente la cirugía tras comprobar la vitalidad pulpar positiva de estos dientes. Con posterioridad a la intervención quirúrgica se realizó la endodoncia de los dientes que habían perdido la vitalidad. En ambos casos el examen histopatológico, mostró la presencia de un fibroma cemento osificante, cuyo diagnóstico inicial clínico y radiográfico, en ocasiones, puede pasar desapercibido.We present two clinical cases of radioluscent mandibular lesions in young women that simulated chronic periapical infectious pathology. The detection of both cases was fortuitous since they were totally assymptomatic. Diagnosis was reached in one case (upon periapical surgery and anatomo-pathologic study) after endodontic treatment and after verifying non-resolution of affected periapical area. The other case was an extensive lesion, which involved the periapices of the four inferior incisors in which surgery was directly performed upon verifying pulp vitality of these teeth. After surgery endodontic treatment was performed on the teeth that had lost their vitality. In both cases the histopathologic tests revealed the presence of a cemento-ossifying fibroma, the initial clinical and radiographic diagnosis of which could easily be overlooked

Bisphosphonates and dental implants: current problems

Osteonecrosis of the jaw has been described in patients taking bisphosphonates after oral surgery procedures, including the placement of dental implants. This review is an update of the relationship between bisphosphonates and dental implants.Results obtained by different authors are compared, contrasting earlier studies where an improvement in implant osseointegration using bisphosphonates was observed, with ones where statistically significant differences were found, and more recent studies disagreeing with the use of bisphosphonates for causing necrosis of the jaw. The differing results obtained between animal studies and the situation observed in humans may be due to a short medication and follow-up period, as well as to the existence of few research studies where dental implants are placed in the oral cavity.Currently, dental implants are contraindicated in patients being treated with intravenous bisphosphonates. In 2007, the American Association of Oral and Maxillofacial Surgeons suggested guidelines for patients treated with oral bisphosphonates, based on the clinical situation of the patient and the length of treatment with the drug, and that greater caution prior and subsequent to surgery should be taken for three years after treatment. All patients treated with bisphosphonates must have the risk of possible loss of implants and the risk of suffering a bony necrosis of the operated jaw explained to them, and give their informed consent prior to dental implant surgery

Irritative and sensory disturbances in oral implantology. literature review

The aim of this study was to review irritative and sensory disturbances following placement of dental implants. A literature search was made of PubMed for articles published between 2000 and 2010. Studies that reported sensory disturbances directly caused by the placement of dental implants were included. Sensory deficits or trigeminal neuropathy are caused by damage to the third branch of the trigeminal nerve du-ring surgery. This manifests in the immediate postoperative period as a sensory deficit not usually associated with pain and generally transient. The literature reviewed reported irritative and sensory disturbances caused during surgery, after surgery, and as a result of complications. Postoperative pain appears after oral surgery as a result of inflammation associated with damage to tissue during surgery. Pain due to postoperative complications following implant placement was classified as neurogenic pain, peri-implant pain and bone pain. © Medicina Oral S. L

Satisfaction of patients fitted with implant-retained overdentures

Objective: to evaluate patient satisfaction with implant-retained overdentures, and its relationship with age, sex, period of follow-up, the rehabilitated jaw (maxilla, mandible or both), number of implants, splinting, type of attachment and the antagonist.Material and methods: the study comprised patients with overdentures fitted between January 1996 and June 2007, and with a minimum follow-up of one year. Data regarding patients and prostheses were collected. The patients indicated their overall satisfaction on a visual analogue scale (VAS) from 0 to 10, as well as satisfaction for individual items such as aesthetics, speech, mastication, prosthetic stability and selfesteem. These data were collected one month after fitting the prostheses, at 12 months and at a final examination. Statistical analyses were made using the SPSS version 15, statistical significance was considered for p<0.05.Results: the study included 95 patients, 43 men and 52 women, with a mean age of 55.9 years; 76 edentulous mandibles and 31 edentulous maxillae were rehabilitated with 107 overdentures. One hundred and thirty-seven implants were placed in the maxilla, and 224 in the mandible. The mean level of overall satisfaction was 9 at one month of fitting the prosthesis, 8.8 at 12 months and 8.7 at the final control (mean 71 months).Conclusions: the patients fitted with implant-retained overdentures expressed a high level of overall satisfaction, independently of age, sex, length of follow-up, rehabilitated jaw, number of implants per overdenture, whether splinted or non-splinted, and type of attachment. Men were more satisfied with mastication and stability

Estudio del dolor e inflamación en 41 pacientes tras la colocación de 131 implantes dentales

Objetivos: Estudiar el dolor y la inflamación durante la primera semana del postoperatorio tras la colocación de implantes dentales. Material y métodos: En 41 pacientes (17 hombres y 24 mujeres) se colocaron 131 implantes con anestesia local. El dolor fue valorado mediante una escala analógica-visual y verbal, y la inflamación con una escala verbal. Resultados: En la mayoría de los pacientes que tuvieron dolor, éste fue leve, y el pico mayor fue a las 6 horas de la intervención en un 41.5% de los pacientes. Existió una relación significativa entre el dolor y el número de implantes colocados. La inflamación fue moderada en la mayoría de los pacientes que tuvieron dolor, y el momento de mayor intensidad fue a las 48 horas en un 48.8% de los pacientes. Existió una asociación significativa entre la inflamación y los pacientes de mayor edad, la colocación de más de 4 implantes dentales, y las intervenciones donde fue realizada elevación sinusal o regeneración ósea. Tuvieron mayor inflamación los pacientes con implantes colocados en la zona posterior frente a los colocados en la zona anterior, y los situados en extremos libres frente a los situados en espacios interdentales o edéntulos totales. Conclusiones: Tras la colocación de implantes el dolor suele ser leve, y la inflamación moderada, ésta es mayor en pacientes de edad avanzada, con más número de implantes y procedimientos con técnicas regenerativas.Aims: To study pain and swelling in the first week after dental implant placement. Material and methods: A total of 131 implants were placed in 41 patients (17 males and 24 females) under local anesthesia. Pain was scored by means of a verbal and visual analog scale (VAS), while swelling was evaluated by a verbal scale. Results: Most patients who experienced pain reported the latter to be slight, with a peak intensity 6 hours after the operation in 41.5% of cases. A significant relation was observed between pain and the number of implants placed. Swelling was moderate in most patients who reported pain peak intensity of inflamm ation being recorded after 48 hours in 48.8% of cases. A significant association was observed between swelling and older patients, the placement of more than four dental implants, and operations in which sinus lift or bone regeneration procedures were carried out. Swelling was greater in patients with implants positioned in the posterior sector versus those placed in the anterior zone, and in those located at free extremes versus those placed in interdental spaces or totally edentulous patients. Conclusions: Following implant placement, pain tends to be mild, with moderate inflammation. The latter is seen to be greater in older patients, in subjects receiving a larger number of implants, and in interventions involving regenerative techniques

Rehabilitation of severely resorbed maxillae with zygomatic implants : an update

Studies highlight the zygomatic bone as a suitable anatomical structure for implant placements since they cross four corticals. Zygomatic implants were described by Branemark in 1998, since then zygomatic implants are indicated in maxillae with atrophy of the posterior area. They have been used in systemic diseases associated with bone loss in this area, and in patients who have suffered radical surgery for maxillofacial tumors. Computed tomography is recommended before placement in order to discount any pathology of the maxillary sinus. The surgical technique has been slightly modified since its description with procedures such as the sinus slot technique. The success rate obtained by different authors varies between 82% and 100%, indicating this technique as a valid treatment option. The objective of this study was to revise the literature with the aim of updating the subject

Bone necrosis around dental implants: a patient treated with oral bisphosphonates, drug holiday and no risk according to serum CTX

Osteonecrosis of the jaw (ONJ) may appear following certain oral surgery procedures in patients treated with oral bisphosphonates (OB). Guidelines for the treatment of these patients were set out in the American Association of Oral and Maxillofacial Surgeons (AAOMS) Position Paper on Bisphosphonate-Related Osteonecrosis of The Jaws (Position Paper) and Approved by the Board of Trustees in September 2006. For the AAOMS the placement of implants in these patients is not contraindicated. In addition, the serum C-terminal telopeptide bone suppressor marker (CTX) test is available to determine the risk of ONJ. A case is presented of ONJ in a patient with 6 months of OB discontinuation ('drug holiday') before dental implant placement (following the guidelines of the AAOMS) and with no risk of osteonecrosis according to the serum CTX value (340 pg/ml). The wound healed favorably with complete healing at 7 months. In this case, the serum CTX test must be questioned as to its predictive value of ONJ, and more reliable markers of this risk are needed