Peri-implantitis as a cause of giant-cell granuloma? Presentation of a clinical case

Introduction: Peri implantitis can be identified by classic clinical and radiographic signs. The aim of this case was to show an original exophytic lesion appeared 8 years after the implantation in the mandibular symphysis. Observations: The patient has been implanted on symphyseal site 8 years ago. The lesion was exophytic and located around mobile implant in right mandible. First curative surgical resection was performed under local anesthesia, combined with explantation of mobile implants. Histhopathological exam identified a giants cells granuloma. A second surgical removal was necessary under general anesthesia because of a severe recurrence. Discussion: The goal of this clinical case was to emphasize the possible correlation between inflammatory peri implantits context and giants cells granuloma. Others techniques could be used to manage this case

Management of postoperative outcomes of polytetrafluoroethylene membranes in alveolar ridge reconstruction: a systematic review

International audienceGuided bone regeneration (GBR) is a validated technique with satisfactory outcomes during 30 years of follow-up.The use of polytetrafluoroethylene (PTFE) membrane for vertical augmentation has been studied extensively.However, studies have reported exposure rates of up to 31%, there is no consensus on the management of postoperative exposure.The objective of this study was to propose a management approach for postoperative exposure of polytetrafluoroethylene (PTFE) membranes in alveolar ridge reconstruction.Material and method: An electronic search in PubMed Central's and additional electronic databases was performed. The search strategy was limited to human studies, full-text English or French articles published from 1990 until april 2023.The extracted data included defect location, membrane type, biomaterials, time to postoperative exposure, and Fontana classification stage.Protocol bias assessment was performed using an adaptation of the QUADAS-2 tool.This review has been registered on PROSPERO (ID: CRD42023445497).Results: A total of 43 articles were found to be eligible, and 11 of these met the predefined inclusion and exclusion criteria.Based on the results of this systematic review, an algorithm for the management of PTFE membrane exposure is proposed.Conclusion: Postoperative membrane exposure is not a determining factor for the success of bone grafting.In cases with postoperative complications, the majority of cases still achieved adequate implant-prosthetic rehabilitation.Lastly, this series of 11 articles was insufficient to draw conclusions regarding good practice recommendations. A larger series is required to validate the specific management approaches

Bone Formation and Maintenance in Oral Surgery: The Decisive Role of the Immune System—A Narrative Review of Mechanisms and Solutions

Based on the evidence of a significant communication and connection pathway between the bone and immune systems, a new science has emerged: osteoimmunology. Indeed, the immune system has a considerable impact on bone health and diseases, as well as on bone formation during grafts and its stability over time. Chronic inflammation induces the excessive production of oxidants. An imbalance between the levels of oxidants and antioxidants is called oxidative stress. This physio-pathological state causes both molecular and cellular damage, which leads to DNA alterations, genetic mutations and cell apoptosis, and thus, impaired immunity followed by delayed or compromised wound healing. Oxidative stress levels experienced by the body affect bone regeneration and maintenance around teeth and dental implants. As the immune system and bone remodeling are interconnected, bone loss is a consequence of immune dysregulation. Therefore, oral tissue deficiencies such as periodontitis and peri-implantitis should be regarded as immune diseases. Bone management strategies should include both biological and surgical solutions. These protocols tend to improve immunity through antioxidant production to enhance bone formation and prevent bone loss. This narrative review aims to highlight the relationship between inflammation, oxidation, immunity and bone health in the oral cavity. It intends to help clinicians to detect high-risk situations in oral surgery and to propose biological and clinical solutions that will enhance patients’ immune responses and surgical treatment outcomes