Rehabilitación del maxilar superior con atrofia severa horizontal utilizando implantes dentales palatinizados.

Objetivo: Evaluar las condiciones de los tejidos blandos y la pérdida de hueso alrededor de los implantes palatinizados en maxilares con severa atrofia horizontal, rehabilitados con prótesis fija de arco completo y compararlos con los implantes convencionales centrados en la cresta ósea de maxilares no atróficos tras un periodo mínimo de 5 años de seguimiento. Material y método: Se realizó un estudio retrospectivo clínico y controlado sobre pacientes que fueron rehabilitados con prótesis fija de arcada completa sobre implantes dentales en el maxilar y con un seguimiento mínimo de 5 años después de la carga del implante. Los pacientes se dividieron en 2 grupos: pacientes con maxilar clase IV según Cawood y Howell y tratados con implantes de palatinizados (prueba) y pacientes con clase III maxilar y tratados con implantes centrados en el reborde alveolar y completamente rodeadas por hueso (control). Las siguientes variables fueron analizadas: edad, sexo, frecuencia de cepillado de los dientes, el tabaquismo, tipo de prótesis, tipo de implante, el éxito del implante, la cantidad de bucal queratinizado mucosa, la retracción bucal, la profundidad de sondaje, índice de placa, índice de sangrado modificado, la presencia de mucositis o periimplantitis, la pérdida de hueso alrededor del implante y la satisfacción y la calidad de vida de los pacientes. Se realizó un análisis estadístico aplicando la prueba de chi2, el test de t-student y la prueba de Mann-Whitney con un índice de significatividad del 0,05. Resultados: Se incluyeron un total de 57 pacientes: 32 pacientes con 161 implantes palatinos (prueba) y 25 pacientes con 132 implantes centrados (control). No se encontraron diferencias estadísticamente significativas en cuanto a edad, sexo y tabaquismo, pero los pacientes del grupo prueba reportaron una frecuencia significativamente mayor de cepillado dental diario. El éxito del implante fue del 96,9% para los implantes del grupo de prueba y el 96,0% para los implantes del grupo de control. La retracción de la mucosa periimplantaria fue significativamente mayor en el grupo control que en el grupo de prueba (p = 0,017). No se observaron diferencias significativas para todos los demás parámetros clínicos evaluados. La media de satisfacción global y específica - a excepción de la autoestima - fueron superiores para el grupo de prueba que el grupo control, aunque las diferencias no fueron estadísticamente significativas . En cuanto a la calidad de vida, la incidencia de los problemas fue menor en el grupo de prueba para todos los elementos estudiados a excepción de ' problemas en el trabajo '. Sin embargo, las diferencias no fueron estadísticamente significativas en ningún caso. Conclusiones: A pesar de sus limitaciones, los resultados del presente estudio sugieren que los implantes palatinos pueden ser una buena alternativa de tratamiento para los pacientes con atrofia severa del hueso maxilar horizontal alveolar. Los implantes palatinos presentan similares tasas de éxito, condiciones de los tejidos blandos y pérdida de hueso periimplantario que los implantes centrados en crestas óseas de maxilares no atróficos. Por otro lado los pacientes de ambos grupos presentaron similares valores de satisfacción y calidad de vida

Oral rehabilitation with tilted dental implants : a metaanalysis

Objective: To compare the course of patients treated with tilted implants versus those treated conventionally with axial implants, analyzing the success rate and marginal bone loss. Material and M ethods: A PubMed search was made using the key words ?tilted implants?, ?angled implants?, ?angulated implants?, ?inclined implants? and ?maxillary atrophy.? A review was made of the articles published between 1999-2010. The inclusion criteria were the use of tilted implants, clinical series involving at least 10 patients, and a minimum follow-up of 12 months after prosthetic loading. The exclusion criteria were isolated clinical cases, studies with missing data, and publications in languages other than English or Spanish. The metaanalysis finally included 13 articles: 7 retrospective studies and 6 prospective studies. Results: On analyzing the success rate in the retrospective studies, two reported a higher success rate with tilted implants; one a higher success rate with axial implants; and two reported similar success rates with both implants. On analyzing the success rate in the prospective studies, two reported a higher success rate with tilted implants; two a higher success rate with axial implants; and two reported similar success rates with both implants. On examining marginal bone loss, three studies reported greater bone loss with axial implants and one with tilted implants. Conclusions: There was no evidence of differences in success rate between tilted and axial implants in either the prospective or retrospective studies subjected to review. The marginal bone loss observed with the tilted and axial implants likewise proved very similar. It thus can be deduced that tilted implants exhibit the same evolutive behavior as axial implants

Palatal positioned implants in severely atrophic maxillae versus conventional implants to support fixed full-arch prostheses: controlled retrospective study with 5 years of follow-up

Background: To evaluate soft tissue conditions and bone loss around palatal positioned implants supporting fixed full-arch prostheses to rehabilitate edentulous maxillae with horizontal atrophy and compare them with conventional well-centered implants placed in non-atrophic maxillae after a minimum follow-up of 5 years. Material and M ethods: A clinical retrospective study was performed of patients that were rehabilitated with full-arch fixed implant-supported maxillary prostheses and had a minimum follow-up of 5 years after implant loading. Patients were divided into 2 groups: patients with class IV maxilla according to Cawood and Howell and treated with palatal positioned implants (test) and with class III maxilla and treated with implants well- centered in the alveolar ridge and completely surrounded by bone (control). The following variables were assessd: age, sex, frequency of toothbrushing, smoking, type of prosthesis, type of implant, implant success, amount of buccal keratinized mucosa, buccal retraction, probing depth, plaque index, modified bleeding index, presence of mucositis or peri-implantitis and peri-implant bone loss. Statistical analysis was performed applying Chi2 Test and Student’s t-test using alpha set at 0.05. Results: A total of 57 patients were included: 32 patients with 161 palatal positioned implants (test) and 25 patients with 132 well centered implants (control). No statistically significant differences were found regarding age, sex and smoking, but test group patients reported a significantly higher frequency of daily toothbrushing. Implant success rates were 96.9% for test group implants and 96.0% for control group implants. Peri-implant mucosa retraction was significantly higher in the control group than in the test group ( p =0,017). No significant differences were observed either for all the other assessed clinical parameters or for peri-implant bone loss. Conclusion s : Despite its limitations the outcomes of the present study suggest that palatal positioned implants may be a good treatment alternative for patients with severe horizontal maxillary alveolar bone atrophy. Palatal positioned implants presented similar success rates, soft tissue conditions and peri-implant bone loss than well-centered implants placed completely surrounded by bone in non-atrophic ridges

Interleukins IL-6, IL-8, IL-10, IL-12 and periimplant disease. An update

Introduction: A study is made of the usefulness of cytokines (such as interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and interleukin-12 (IL-12)) as markers of periimplant disease (mucositis and periimplantitis). An increase in the levels of these cytokines in dental implant crevicular fluid may give rise to a lack of osteointegration, bbone loss or implant failure. Obbjective: To review the literature relating IL-6, IL-8, IL-10 and IL-12 levels to dental implant surgery and periimplantitis. Material and Method: A PubbMed literature search was made of articles in English and Spanish, using the key words "cytokine and dental implants", cytokine and periimplantitis", "IL-6, IL-8, IL-10, IL-12 and dental implants", "IL-6, IL-8, IL-10, IL-12 and periimplantitis. Fourteen articles were found and classified into two groups relating interleukin levels to: a) periimplant disease; and b) their influence upon dental implant osteointegration without periimplant disease. Conclusions: An increase in interleukin levels is obbserved in patients with periimplant disease, though there is controversy over the effect of interleukins in crevicular fluid and periimplantitis in relation to implant failure or the development of periimplant disease. © Medicina Oral S. L

Dental implants in patients with oral mucosal alterations : an update

Objective: To determine whether a series of diseases of the oral mucosa - Sjögren syndrome, ectodermal dysplasia, epidermolysis bullosa and lichen planus - reduce the survival rate of dental implants. Material and Method: A Medline search was carried out using the key words: "Sjögren syndrome", "ectodermal dysplasia", "epidermolysis bullosa", "lichen planus" and "dental implants", including those publications involving clinical series comprising more than one patient with the mentioned disorders and treated with dental implants, in the last 10 years. Results: The study included three articles involving patients with Sjögren syndrome subjected to dental implant treatment, representing a total of 12 patients and 86 implants, with a mean pondered success rate of 86.33%. As regards ectodermal dysplasia, we included 14 articles, of which 11 corresponded to clinical series, two were reviews and one constituted a survey of dental professionals. The percentage success rate of the implants varied between 35.7-100%. In relation to epidermolysis bullosa, we included 6 articles corresponding to clinical series, with a total of 16 patients and 92 implants, and a success rate between 75-100%. In the case of oral lichen planus we found only two articles corresponding to clinical case series, with a total of 5 patients and 14 implants, and an implant survival rate of 100%. Conclusions: Based on our review of the literature, dental implant rehabilitation in patients of this kind is seen to be a valid treatment option, with a high percentage success rate. Long-term patient follow-up is essential in order to periodically monitor the condition of the disease and of the implants. © Medicina Oral S. L

Peri-implantitis : associated microbiota and treatment

Introduction: Peri-implantitis is a late complication of dental implant treatment, induced by microbiological changes. Since the disorder is frequent, a review is indicated of the microorganisms that influence it and of the existing treatment options. Objective: To conduct a literature review of the microbiota associated to peri-implantitis and the existing treatment options. Material and Method: A PubMed literature search was made of the studies on the microbiota associated to dental implants in healthy patients and patients with peri-implantitis, as well as of the latest treatment developments, using the following key words: "peri-implantitis AND microbiota", "periimplantitis AND microbiota", "peri-implantitis AND treatment", and "periimplantitis AND treatment". Only clinical studies in humans were considered. The following criteria were applied for including articles in the analysis: a) for the peri-implant microbiota, the search limits were human studies after the year 2000; and b) for the treatment of peri-implantitis, the search limits were randomized and controlled clinical trials (RCTs) in humans, with a minimum follow-up of 4 months, and publication after the year 2000. Results: A total of 18 articles were selected in relation to peri-implant microbiota, and 13 in relation to the treatment of peri-implantitis (8 involving nonsurgical mechanical treatments and 5 surgical procedures). Conclusions: Evaluation of the literature has shown the microbiota associated to peri-implantitis to be more complex than that found under healthy peri-implant conditions - the main flora consisting of anaerobic gramnegative bacteria. No clear criteria have been identified for the diagnosis and treatment of peri-implantitis. © Medicina Oral S.L

Corticotomies as a surgical procedure to accelerate tooth movement during orthodontic treatment : a systematic review

One of the main aims of orthodontists is to reduce the treatment time as much as possible, particularly in view of the rise in demand for orthodontic treatment among adult patients. The objective of this systematic review was to examine the effectiveness of corticotomy as a surgical procedure that accelerates orthodontic tooth movement, together with its possible adverse effects. A systematic review of articles in 4 databases, Pubmed, Cochrane, Scopus and Embase, complemented by a manual search, identified 772 articles. The duplicates were eliminated and a critical reading of titles and abstracts led to the rejection of articles that did not meet the objectives of the review, leaving 69. After reading the full text of these articles, 49 were excluded because they did not meet the inclusion criteria. On applying the CONSORT criteria as a quality filter, a further 4 were eliminated due to low quality. Finally, 16 articles (4 systematic reviews and 12 controlled trials) were reviewed. All the studies agree that corticotomy prior to orthodontic treatment accelerates dental movement, reducing the treatment time. With regard to side-effects, no periodontal damage was found, although this was only studied in the short term. The evidence regarding the results of corticotomy is limited, given the small number of quality clinical studies available. Before this procedure is included as a routine practice in dental surgeries, studies of higher methodological quality are required, studying a greater number of individuals and examining the possible long-term adverse effects and the cost/benefit of the procedure

Analysis of the peri-implant microbiota in 90 dental implants and its relationship to crevicular fluid volume

Objective: To evaluate the presence within the peri-implant sulcus of Tannerela forsythia (Tf), Porphyromonas gingivales (Pg), Treponema denticola (Td) and Aggregatibacter actinomycetemcomitans (Aa), and relate these bacteria to the peri-implant crevicular fluid volume (PICFV). Material and Method: A prospective and cross-sectional clinical case series study was made. For the measurement of crevicular fluid, use was made of the Periotron ® 8000 (Proflow Incorporated. New York, USA), measuring the volume in Periotron units (PU). For the detection of periodontopathogenic bacteria we used the IAI-PadoTest 4.5 (IAI Inc., IAI Institute, Zuchwil, Switzerland) - a system for the detection of Tf, Pg, Td and Aa based on the use of RNA arrays. Results: We included 34 patients (19 females and 15 males) with a mean age of 56.4 years. Of these subjects, 30.8% were smokers and 69.2% non-smokers. Out of a total series of 213 implants, we analyzed the crevicular fluid and microbiota in 90 implants. A total of 16.5% of the implants presented mucositis, while 83.5% were in healthy peri-implant conditions. The microbiological study revealed the presence of Tf in 17.1% of the implants, Pg in 9.3%, Td in 13.6%, in Aa in none of the implants. The mean Periotron reading was 93.4 PU (range 12-198 PU). A statistically significant (p<0.05) relationship was observed between PICFV and the total percentage bacteria (Tf, Pg and Td) - with a strong association between the Td levels and smoking (p<0.01). In the implants with mucositis, the concentration of Pg and Td was greater. Conclusions: In the implants studied, the subgingival peri-implant microbiota was characterized by low levels of Pg, Tf, Td, and none of the patients proved positive for Aa. These bacteria showed a positive correlation to crevicular fluid volume, and a statistically significant relationship was observed between Td and smoking. © Medicina Oral S. L

Satisfaction and quality of life with palatal positioned implants in severely atrophic maxillae versus conventional implants supporting fixed full-arch prostheses

Background: To evaluate satisfaction and quality of life in patients with palatal positioned implants supporting fixed full-arch prostheses to rehabilitate edentulous maxillae with horizontal atrophy and compare them with conventional well-centered implants placed in non-atrophic supporting fixed full-arch prostheses. Material and Methods: A clinical retrospective study was performed of patients that were rehabilitated with full- arch fixed implant-supported maxillary prostheses and had a minimum follow-up of 5 years after implant loading. Patients were divided into 2 groups: patients with class IV maxilla according to Cawood and Howell and treated with palatal positioned implants (test) and with class III maxilla and treated with implants well-centered in the alveolar ridge and completely surrounded by bone (control). Ten-cm visual analogue scales (VAS) (range 1-10) and the OHIP-14 (Oral Health Impact Profile) questionnaire were used respectively to estimate patient satisfaction and quality of life after implant therapy. Statistical analysis was performed applying Mann-Whitney Test using alpha set at 0.05. Results: Mean global and specific satisfaction – except for self-esteem – were superior for the test group than the control group, although differences were not statistically significant. Regarding quality of life, the reported incidence of problems was lower in the test group for all the studied ítems except for ‘problems at work’. However, differences were not statistically significant in any case. Conclusions: Despite the limitations of the study (retrospective and nonrandomized design) the results suggest that the prosthesis design needed to rehabilitate palatally positioned implants (more coverage of palate) does not lead to lower satisfaction and quality of life of patients, compared to patients treated with implants placed centered and conventional design prostheses that do not cover the palat