Changing Preference of One- Vs. Two-Stage Implant Placement in Partially Edentulous Individuals: An 18-Year Retrospective Study

The purpose of the present long-term retrospective study was to assess the changing preference of one- vs. two-stage implant placement in partially edentulous individuals. The clinical outcome measures were one- vs. two-stage implant placement, implant survival, and gingival index. The radiological outcome measure was crestal bone loss. Other recorded information included gender, age, implant characteristics (brand, type, length, diameter) and implant location (maxilla/mandible). A total of 393 implants in 111 patients were included. The results revealed that there were no significant demographic differences between the one- and two-stage implant placement groups. There was a preference for one-stage surgery when wide diameter implants were used and when the number of implants per patient was ≤3. The mandible was the major implant site in the one-stage surgery group. Crestal bone loss and gingival index were similar for the two groups in both the short and long term. It can be concluded that lack of any long-term differences in implant survival, crestal bone loss and gingival health around implants after one- or two-stage implant placement promoted a significant change over 18 years, increasing to 50% the prevalence of one-stage surgery

Sinus Augmentation with Simultaneous, Non-Submerged, Implant Placement Using a Minimally Invasive Hydraulic Technique

Background and objectives: To evaluate whether sinus augmentation, using a minimally invasive implant device, via a non-submerged surgical approach, might negatively influence the outcome. Materials and Methods: A retrospective cohort study was conducted by evaluating patients’ files, classifying them into two groups. Fifty patients (22 men 28 women) were included in the study, 25 in each group. The use of an implant device based on residual alveolar ridge height for sinus augmentation, radiographic evaluation, insertion torque, membrane perforation, post-operative healing, and a minimum of 12 months follow-up were evaluated. Results: The mean residual alveolar ridge height was 5.4 mm for the non-submerged group and 4.2 mm for the submerged group. There were no intraoperative or postoperative complications (including membrane perforations). The mean insertion torque was 45 N/cm for the study group and 20 N/cm for the control group. Complete soft tissue healing was observed within three weeks. Mean bone gain height was 8 mm for the study and 9.3 mm for the control group. All implants osseointegrated after 6–9 months of healing time. Mean follow-up was 17.5 months, range 12–36 months. Marginal bone loss at last follow-up was not statistically significantly different: 1 mm in the non-submerged vs. 1.2 mm in the submerged group. Conclusions: Submerged and non-submerged healing following maxillary sinus augmentation was comparable provided residual alveolar ridge height >5 mm and insertion torque >25 N/cm

Sclerotherapy of Vascular Malformations in the Oral Cavity—Minimizing Postoperative Morbidity

Vascular malformations (VMs) are a wide vascular or lymphatic group of lesions common on the head and neck. The objective of this study was to assess the efficacy and morbidity of sclerotherapy for the treatment of VMs in the oral and perioral area. Special attention was given to factors that may contribute to minimizing postoperative morbidity. Data from 25 patients (32 lesions) with oral VMs submitted to sclerotherapy with monoethanolamine oleate (EAO) were included. A structured form was used to collect data. An arbitrary score was determined to evaluate postoperative morbidity. Each of the following signs or symptoms received one point: pain, swelling, hematoma, ulceration, erythema, transient numbness, and transient itching. Pain and swelling were further divided into mild to moderate (1 point) and severe (2 points). Theoretically, the score was in the range of 0–9. Calculated scores ranged 0–4. The patients were further divided into two groups with scores of 0–1 denoting minimal morbidity (MIN) and 2–4 denoting significant morbidity (SIG). The number of lesions in each morbidity-score group were comparable (MIN 17and SIG 15). There were no statistically significant differences between the groups regarding age, number of applications, or average injection volume per mm lesion. Statistically significant differences were noted regarding gender (p = 0.05), lesion diameter (p = 0.030), total volume of first (p = 0.007) and second application (p = 0.05), and total injected volume (p = 0.03). Factors contributing to the risk for significant morbidity included being male, lesion diameter > 5 mm, volume > 0.3 mL per application, and total injected volume > 0.3 mL. A waiting time of 12 weeks prior to additional EAO application was required in 12 out of 29 lesions for clinical observation of complete regression. It was concluded that sclerotherapy with EAO as monotherapy is easy to apply, safe, and effective within a small number of sessions. Application of <0.3 mL EAO per session, and a waiting time of 12 weeks prior to the second application, would significantly minimize morbidity

Palatal Wound Healing with Primary Intention in a Rat Model—Histology and Immunohistomorphometry

Background and objectives: Subepithelial connective tissue graft (SCTG) from the palate has been considered as the “gold standard” for the treatment of deep gingival recessions. A single-incision technique was reported to allow primary wound healing. A palatal single incision was performed in a rat model. The present study assessed the histology and histomorphometry of palatal wound healing following surgical closure with primary intention. Materials and Methods: Twenty-six 6-month-old male Wistar rats weighing 427–650 g. An incision was made on the maxillary palate. A full thickness flap was raised palatally, and then repositioned and sutured. Two experimental groups: S—Study group, I—Intact control group. Half of the animals were sacrificed 7 days and the remaining 14 days postoperatively. Outcome parameters included—epithelial gap; inflammatory infiltration; vascular fraction, expression of myofibroblasts and stem cell markers within the oral epithelium and stromal cells and physical properties of stromal collagen fibers. Investigations were performed at two time-points (7 and 14 days) during the wound healing process. Results: The epithelial gap closed completely after 14 days. The inflammatory reaction and vascular fraction were relatively low. Surgical trauma downregulated the expression of cytokeratin (CK) 14 and CK 15, which returned to normal after 14 days. Epithelial differentiation was mediated through upregulation of connective tissue sex- determining-region-Y-box2 (SOX2). Epithelial SOX2, CD34, alpha smooth muscle actin (αSMA) and physical properties of stromal collagen fibers were not influenced by the surgical trauma. Conclusions: Surgical trauma followed by palatal wound healing with primary intention in a rat model heals within 14 days. It induces minimal inflammatory infiltration and vascular proliferation. Epithelization is exerted through promotion of epithelial differentiation from stem cells by connective tissue SOX2

Effects of peri-implant infection on serum biochemical analysis.

BACKGROUND Peri-implant disease (PID) has not been directly linked to pathological organ changes. The present study assessed the dynamics of serum biochemical parameters in a model of experimental peri-implantitis in dogs, followed by open flap debridement. MATERIAL AND METHODS Seven male Beagle dogs comprised the study group. Procedures were performed as follows-extractions of two premolars and one molar on each mandibular quadrant (Day 0); bone healing time (week14); placement of four rough-surface endoosseous implants, two on each mandibular side; implant uncovering (week 28); induction of experimental peri-implantitis by the use of three ligatures (weeks 31, 34, 37) followed by open flap debridement (week 42). Serum biochemical analysis following each procedure was compared to baseline. Biochemical parameters were assigned into four subsets of variables-inflammation, renal function, liver function, and blood glucose. Wilcoxon paired tests were conducted in order to identify statistically significant differences between baseline data and values obtained after each procedure RESULTS: Following experimental peri-implantitis, the dynamics of renal parameters and blood glucose were minimal whereas statistically significant (P < 0.05) increases were noted for inflammatory (total protein and albumin concentrations) and hepatic (ALT, AST) parameters. A statistically significant (P < 0.05) decrease was only noted for total bilirubin. After open flap debridement, inflammatory (total protein and albumin concentrations) and hepatic (AST) parameters returned to baseline. CONCLUSIONS Within their limits, the present results indicate that: (a) PID affects inflammatory and hepatic serum biochemical parameters, and (b) following open flap debridement most of the values returned to baseline

Peri-implant disease affects systemic complete blood count values-an experimental in vivo study.

OBJECTIVES To assess complete blood count (CBC) dynamics following ligature removal and open flap debridement in experimental peri-implantitis in dogs. MATERIALS AND METHODS Seven male beagle dogs were included in the study. Four rough-surface implants were placed pair-wise in both sides of the mandible 14 weeks after tooth extraction. Second stage surgery was performed after 14 weeks. Experimental peri-implantitis was initiated 3 weeks later by ligature placement around the healing caps thus facilitating plaque accumulation and inducing inflammation and destruction of peri-implant tissues. Ligature removal and open flap debridement were performed 11 weeks later. The CBC values were compared with baseline after each procedure. Wilcoxon paired tests were conducted in order to identify statistically significant differences between baseline data and values obtained after each procedure. RESULTS Following experimental peri-implantitis, statistically significant (p < 0.05) increases were noted for white blood cells-WBC (9.62 ± 4.34 vs. 6.48 ± 1.34 cells per microliter of blood × 1000), hemoglobin-Hb (15.25 ± 0.94 vs. 13.52 ± 1.46, grams per deciliter), red blood cells-RBC (7.26 ± 0.79 vs. 5.9 ± 0.61 cells per microliter of blood × 1000), mean corpuscular hemoglobin-MCH (23.64 ± 0.96 vs. 23.16 ± 0.83 picograms/cell), platelets-PLT (349.86 ± 51.05 vs. 277.57 ± 66 cells per microliter of blood × 1000), and mean corpuscular hemoglobin concentration-MCHC (35.83 ± 0.27 vs. 31.04 ± 0.48 grams per deciliter). A statistically significant (p < 0.05) decrease in values was noted only for after ligature removal and open flap debridement. Mean corpuscular volume-MCV values were significantly lower (65.99 ± 2.31 vs. 74.65 ± 2.85 femtoliter) following 1st ligature. Values returned to baseline after open flap debridement. CONCLUSIONS Within its limits, the present data suggest that experimentally induced peri-implantitis affects CBC values. Following surgical treatment, CBC values returned to normal. Clinical relevance This is the first study suggesting possible relationships between peri-implantitis and CBC values. Future studies, confirming such correlation, may provide an insight into the importance of peri-implant maintenance and treatment to minimize supporting tissues disease and reduce systemic effects

Age-Related Palatal Wound Healing: An Experimental In Vivo Study

We assessed age-related excisional palatal mucoperiosteal wound closure in rats. A 4.2 mm diameter punch was used to create a secondary healing defect in the palate of Wistar rats. Study group—21, 18-month-old vs. control 21, 2-month-old males. The 2-dimensional area, maximum length and width of the soft tissue defect served as clinical outcome parameters. The dynamics of the initial three healing weeks were assessed. Semi-quantitative histomorphometric analysis of inflammation and myofibroblasts served for the evaluation of the inflammatory and proliferative wound healing phases. Complete wound closure was faster in the old rats. A dimensional related wound closure was observed in the young rats versus a symmetrical wound closure in the old rats. Inflammatory response was significantly delayed and of lower intensity in the old rats. Myofibroblastic response, representing the proliferative stage, was delayed and of lower intensity in the old rats, albeit not statistically significant. Reduced initial tissue damage due to decreased and delayed inflammatory response in the old rats ultimately led to faster clinical wound healing compared to the young rats, despite a statistically non-significant lower proliferative response in the old rats

Minimizing MRONJ after Tooth Extraction in Cancer Patients Receiving Bone-Modifying Agents

Background: Medication-related osteonecrosis of the jaws (MRONJ) is a mucosal lesion of the maxillofacial region with necrotic bone exposure. MRONJ is believed to be multifactorial. Tooth extraction is debatably a risk factor for MRONJ. The targets of the present study were to examine MRONJ occurrence in patients using bone modifying agents (BMAs) for oncology indications and undergoing a dental extraction, and to assess whether suspected predisposing factors can predict MRONJ. Materials and Methods: This retrospective, cohort study included all patients fitting the inclusion criteria and a large tertiary medical center. Data were obtained from the hospital’s medical records using a structured questionnaire. Results: We performed 103 extractions on 93 patients. Local inflammation/infection of the extraction site was most associated with a complication (p = 0.001) OR = 13.46, 95% CI = (1.71, 105.41), OR = 13.5. When the indication for extraction was periodontal disease, vertical root fracture, or periapical pathosis, the odds of developing MRONJ were 4.29 times higher than for all other indications (p = 0.1), OR = 4.29, 95% CI = (1.16, 15.85). A significant association was found between the time of onset of BMA treatment and time of extraction and the development of MRONJ, OR = 3.34, 95% CI = (1.01, 10.18). Other variables did not correlate with the development of MRONJ. Conclusion: Local inflammation/infection and onset of BMA treatment prior to extraction yield a 10.23 times higher chance of developing MRONJ following tooth extraction. Future protocols should use this information to minimize MRONJ incidence

Screw-Type Collar vs. Non-Screw-Type Collar Implants&mdash;Comparison of Initial Stability, Soft Tissue Adaptation, and Early Marginal Bone Loss&mdash;A Preclinical Study in the Dog

Background: Implant neck characteristics may affect initial implant stability, soft tissue healing, and early marginal bone loss (EMBL) at second-stage surgery. The null hypothesis was that, following two-stage implant insertion, rough surface, non-screw-type collar implants will present lower EMBL at 2nd-stage surgery than rough-surface, screw-type collar implants. Methods: The study comprised seven male beagle dogs (mean weight 10.57 &plusmn; 2.8 kg; range 9&ndash;17 kg). A novel implant design was developed, composed of 2 parts: an apical part resembling a regular threaded implant, and a coronal non-screw-type collar, 4.2 mm long, served as the study group, whereas standard threaded implants served as control. Twenty-eight implants were placed: two on each side of the mandible. All implants were sand-blasted/acid-etched and of similar dimensions. Each dog received four implants. To assess location (anterior vs. posterior) impact on the outcomes, implants were placed as follows: group I&mdash;posterior mandible right&mdash;non-screw-type collar implants; group II&mdash;anterior mandible right&mdash;similar non-screw-type collar implants. To assess the collar-design effect on the outcomes, implants were placed as follows&mdash;Group III&mdash;anterior mandible left&mdash;control group, screw-type collar implants; Group IV&mdash;study group, posterior mandible left&mdash;non-screw-type collar implants. The following parameters were measured and recorded: insertion torque, soft tissue healing, early implant failure, and EMBL at 2nd-stage surgery. Results: No statistically significant differences were noted between groups I and II regarding all outcome parameters. At the same time, although insertion torque (55 N/cm) and early implant failure (0) were similar between groups III and IV, group III presented significantly poorer soft tissue healing (1.43 vs. 0.14) and increased marginal bone loss (0.86 vs. 0 mm). Conclusions: When a two-stage implant protocol was used, rough-surface non-screw-type collar implants led to superior outcomes at 2nd-stage surgery. Implant location did not affect the results. The significance of this result in preventing EMBL awaits further research