Impact of local and systemic factors on the incidence of oral implant failures, up to abutment connection

Antiresorptive Therapy to Reduce Fracture Risk and Effects on Dental Implant Outcomes in Patients With Osteoporosis: A Systematic Review and Osteonecrosis of the Jaw Taskforce Consensus Statement

OBJECTIVE

Placement of a dental implant in a patient on antiresorptive therapy has been hypothesized to increase the risk of medication-related osteonecrosis of the jaw (MRONJ) and/or impact implant survival. In patients with osteoporosis, the risk of MRONJ with antiresorptive therapy is only marginally higher than observed in the general population.

METHODS

The International ONJ Taskforce conducted a systematic review of the literature and evaluated the outcomes of implant placement in individuals with osteoporosis receiving antiresorptive therapy.

RESULTS

The data were reviewed by the International Taskforce, and consensus was achieved on the following GRADEd recommendation. In patients with osteoporosis on antiresorptive therapy, the Taskforce suggests that antiresorptive therapy does not need to be stopped prior to proceeding with dental implant (weak recommendation, very low-quality evidence). Long-term bisphosphonate use maybe associated with a small increase in the risk of MRONJ (3 cases per 1000 patients; adjusted hazard ratio: 4.09, 95% CI: 2.75-6.09, P < .001, moderate certainty).

CONCLUSION

Current evidence does not suggest an association between antiresorptive therapy in patients with osteoporosis and dental implant failure. Implants may be safely placed in the presence of concomitant use of bisphosphonates or denosumab in patients with osteoporosis with no evidence of an increased risk of implant failure/compromise.

Survival of dental implants placed in a postgraduate educational setting: a retrospective cohort study

INTRODUCTION

Dental implant treatment can still fail due to various factors. The aim of this retrospective cohort study was to assess the influence of operator experience in a postgraduate educational setting, as well as patient, implant, and surgical risk factors on the incidence of the dental implant failure.

METHODS

The dental records of 1049 implants with a mean follow-up of 794.70 days were analysed. Variables included operator experience (year of specialty study) and clinic-pathological patients' related variables. Clinic-pathological associations were explored and a Cox regression model accounted for implant survival factors.

RESULTS

Multivariate analysis revealed that a history of periodontitis and smoking were the only factors with independent prognostic value, with hazard ratios of 2.0 (95 % CI: 1.0-4.0, p = 0.048) and 1.9 (95 % CI: 1.0-3.6, p = 0.039) respectively. Conversely, despite implant treatment delivered by early career students had a higher failure rate (5.6 %) compared to advanced career students (3.7 %), this difference was statistically significant only in the univariate analysis.

CONCLUSION

Periodontitis and smoking are independent prognostic variables, with career level potentially biasing complex case allocation to advanced students. Targeted educational interventions, including virtual reality and artificial intelligence, should be emphasized in student training. University-based implant trials must consider operator career stage.

CLINICAL SIGNIFICANCE

The study underscores the importance of operator experience in dental implant success. It highlights that while clinical experience influences outcomes, factors like a history of periodontitis and smoking are independent predictors of implant failure. These findings emphasize the need for targeted educational interventions to improve clinical training and patient outcomes.

Clinical Evaluation of Implant Stability in Poor Quality Maxillary Bone: Reverse Drilling vs Osteotome Techniques: A Randomized Controlled Clinical Trial

AIM

The current study was conducted to evaluate the potential of a dental implant placed with a new reverse drilling technique (test group) as an alternative treatment option to a dental implant placed with an osteotome technique (control group) according to primary implant stability.

MATERIALS AND METHODS

With fourteen patients in each group, twenty-eight implants were positioned in the posterior maxilla and split equally between two groups: Group A (new reverse drilling technique) and group B (osteotome technique). Periotest M (PTV) was used to measure implant stability, cone-beam computed tomography (CBCT) was used to measure crestal bone loss (mm) and bone density Hounsfield units (HU), and the visual analog scale (VAS) was used to measure pain and swelling. The patients were monitored for 5 months. For statistical analysis, SPSS (version 20) was utilized, and statistical significance was established at p < 0.05.

RESULTS

Regarding the primary outcome of the study, the primary stability of the control group (osteotome technique) showed higher primary stability than the test group (reverse drilling technique). The Mann-Whitney U test revealed that this difference was not statistically significant (p = 0.4820) with a mean value of 0.23 and ±0.33 standard deviation. Crestal bone loss was 0.13 ± 0.06 mm greater measured mesially in the osteotome group and 0.04 ± 0.07 mm greater measured distally in the osteotome group. In each case, the differences were not statistically significant according to independent samples t-tests (mesial: p = 0.05974; distal: p = 0.55541).

CONCLUSION

The two implant placement protocols showed comparable implant stability (PTV) and implant success; the reverse drilling technique is potentially a viable option for the treatment of patients with poor bone quality.

CLINICAL SIGNIFICANCE

The reverse drilling technique can be used as an alternative to the osteotome technique when placing implants in the posterior maxilla for its comparatively reduced invasiveness and higher patient acceptance in terms of pain and swelling. How to cite this article: Awad MM, El Nawawy M, El Refaie I, et al. Clinical Evaluation of Implant Stability in Poor Quality Maxillary Bone: Reverse Drilling vs Osteotome Techniques: A Randomized Controlled Clinical Trial. J Contemp Dent Pract 2025;26(1):10-17.

Smoking in relation to early dental implant failure: A systematic review and meta-analysis

OBJECTIVE

To assess the association between smoking and early dental implant failure by conducting a systematic review and meta-analysis of observational studies.

DATA SOURCES

PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were systematically searched for reports of relevant studies addressing the relationship between smoking and early dental implant failure published between database inception and June 2024.

STUDY SELECTION

Thirty-two observational clinical studies published between 1994 and 2024 were included, with a total of 59,246 implants at implant level and 14,115 patients at individual level. At implant level, a meta-analysis of 21 included cohort studies showed that smoking was associated with increased risk of early dental implant failure compared with non-smoking (odds ratio [OR], 2.59; 95 % confidence interval [CI], 2.08-3.23). Three included studies reported that smoking was associated with higher maxillary early dental implant failure risk (OR, 5.90; 95 %CI, 2.38-14.66) than that of mandible (OR, 3.76; 95 %CI, 1.19-11.87). At individual level, meta-analysis of thirty cohort studies indicated that risk of early implant failure in smokers was 100 % higher than in non-smokers (OR, 2.00; 95 %CI, 1.43-2.80). Three case-control studies found that risk of early implant failure of smokers was 59 % higher than that of non-smokers (OR, 1.59; 95 %CI, 1.28-1.97).

CONCLUSIONS

Smoking was significantly associated with early dental implant failure, particularly at the maxillary location, at both implant and individual level. These findings suggest smoking cessation is a crucial factor in reducing risk of early dental implant failure.

CLINICAL SIGNIFICANCE

There is uncertainty about the extent to which smoking influences early dental implant failure, our meta-analysis of findings emphasize smoking was significantly associated with early dental implant failure, particularly at the maxillary location.

Soft and hard tissue evaluation for vestibular socket therapy of immediately placed implants in infected and non-infected sockets: a 1-year prospective cohort study

BACKGROUND

Immediate implant placement using vestibular socket therapy (VST) proved to offer a successful treatment option in compromised sockets. However, the presence of active signs infection complicates immediate implants in sockets with defective labial plates, due to the possible contamination of the implant or the bone graft with existing infected tissues or oral environment via the fistula. This study, therefore, aims to explore the success of immediate implant placement using VST in managing infected compromised sockets.

METHODS

We included 26 age- and sex-matched patients with 41 implants sites. Thirteen patients had 19 infected (group I) and 13 had 21 non-infected type 2 sockets (group N). Both groups were treated using vestibular socket therapy (VST) and a 6-day protocol. Implant survival, changes in facial bone thickness, and mid, mesial, and distal mucosal levels were evaluated 1 year after implant placement. The Mann-Whitney U test was used to compare both groups. Furthermore, the Wilcoxon signed-rank test was used to study changes with time within each group. The statistical significance level was set at P < 0.05.

RESULTS

All implants survived; no significant difference was found between groups N and I regarding apical, mid, and crestal bone thickness and soft tissue level, except at the mesial papilla, where the recession was significantly more in group N than in group I. Changes over time were statistically significant in the apical, mid, and crestal bone thickness in both groups. The mean bone thickness gain ranged from 0.85 to 2.4 mm and 0.26-1.63 mm in groups I and N, respectively. Additionally, the mean mucosal recession ranged from 0.29 to 0.51 mm and 0.39-1.47 mm in groups I and N, respectively.

CONCLUSION

Within the limitations of this study immediate implant placement in type II infected sockets using the 6-day protocol and VST achieved 100% implant survival, while maintaining the regenerated facial bone thickness with minimal mucosal recession.

TRIAL REGISTRATION

The protocol for this study was registered on clinicaltrials.gov at 3/10/2021 (registration number NCT04787224).

Involvement of IL-10 gene polymorphism (rs1800896) and IL-10 level in the development of periimplantitis

BACKGROUND

Dental implant loss is the worst problem. Today, implant failure is precisely characterized, however the underlying reasons vary by instance. Multiple implant failures indicate genetic risk factors.

METHODS

This cross-sectional study included 80 subjects (15 peri-implantitis patients, 35 successful implants and 30 healthy controls); their mean age was 44.22±10.936 years). Blood samples and peri-implant sulcular fluid (PISF) were collected from all subjects (patients with peri-implantitits, successful implants and healthy controls) attending the Department of Oral and Maxillofacial Surgery in the Dental College Teaching Hospital/Baghdad University, and Shahid Ghazi Al-Hariri Hospital/Medical City Baghdad, Iraq. The blood sample is used for the detection of gene polymorphism of Interleukin-10 conducted by a polymerase chain reaction. While the PISF is used to measure IL-10 level by enzyme-linked immunosorbent assay (ELISA).

RESULTS

In the peri-implantitis group, CC genotypes had higher PISF for IL-10 than TC and TT genotypes (P<0.05). IL-10 genetic polymorphism indicated an odds ratio of genotype related to peri-implantitis, with the C/C genotype having a 0.4-fold greater risk (P=0.0035). In the peri-implantitis group, the T/C genotype had a 1.3-fold greater risk (P<0.05) and the T/T genotype had a one-fold increased risk.

CONCLUSIONS

The polymorphisms of IL-10 rs1800896 evaluated were not predictive of the failure of dental implants. However, a significant association between peri-implant disease and IL-10 level could be observed.

Risk factors associated with early implant failure: A retrospective review

PURPOSE

The purpose of this study was to investigate the association between possible risk factors and early implant failure.

PATIENTS AND METHODS

This retrospective cohort study included consecutive patients receiving dental implant treatment in a four-year timeframe. Patient-related variables (age, sex, smoking, and systemic disease), local factors (area, reason for tooth extraction, and bone quality), surgical variables (bone augmentation, time of implant placement, staging, and antibiotic prophylaxis), and implant-related factors (brand, length, and diameter) were analyzed. Bivariate analyses and multivariate logistic regression model were used to determine the variables associated with early implant failure.

RESULTS

The study group comprised 1323 implants in 738 patients with a mean of 1.8 implants/patient of which, 53 failed in 52 patients in the early stage (before final prosthetic loading). According to the multivariate model, smoking (Odds Ratio=1.836, P=0.031), posterior maxillary region (OR=2.958, P=0.006), implantation in place of teeth extracted due to periodontal problems (OR=2.531, P=0.004), bone type IV (OR=2.881, P=0.008), implant in previously augmented site (OR=2.239, P=0.014), and immediate provisional prosthesis (OR=3.418, P=0.019) were associated with a significantly higher risk of early implant failure. Narrow implants showed a significantly higher risk of early failure in bivariate analyses (P=0.012). However, the effect was no longer significant in the multivariate model (OR=2.322, P=0.068).

CONCLUSION

Early implant failure would be more expected in smokers, posterior maxilla, history of periodontal problems, type IV bone, augmented bone, and immediately loaded cases.

The role of the general dental practitioner in the care of the implant patient

Introducing dental implants into a patient's oral health plan requires a collaborative effort between all members of the care team, including the "implant dentist" and referring general dental practitioner (GDP), should the treatment be carried out in a referral practice. This article aims to discuss the pivotal role referring general dental practitioners (GDPs) play in preparing patients for dental implant placement, whatever the setting for the planned treatment. An overview of the patient referral process is outlined, as is the role of GDPs in the ongoing maintenance of the dental implants and the patient's oral health. Furthermore, this article may be viewed as a road map for GDPs who refer patients to an "implant dentist" as part of their treatment plan.

Effects of adjacent periodontitis on osseointegrated dental implants

PURPOSE

This study aimed to investigate whether new-onset periodontitis or apical periodontitis in the adjacent teeth affects osseointegrated dental implants in a beagle dog model.

METHODS

One control group and 2 experimental groups (periodontitis and apical periodontitis groups) were defined based on the presence of experimental periodontitis or apical periodontitis, with 1 beagle dog randomly assigned to each group. The mandibular second and fourth premolars on both sides of the 3 beagles were extracted. Eight weeks after extraction, 4 bone-level implant fixtures, 2 on both sides of each mandible, were placed in each beagle. Six weeks after implant surgery, healing abutments were connected. After sufficient osseointegration, plaque control was performed in the control group, while periodontitis and apical periodontitis were induced in the experimental groups. The beagles were euthanized for histological analyses 20 weeks after induction of experimental periodontitis. Statistical analyses were performed using the Kruskal-Wallis test with the Bonferroni correction to compare the 3 groups.

RESULTS

The implants in the control and apical periodontitis groups were well-maintained, while those in the periodontitis group showed clinical signs of inflammation with bone resorption. The bone-to-implant contact (BIC) and bone area values in the periodontitis group were lower than those in the other groups. The distance between the implant shoulder and the first BIC was significantly greater in the periodontitis group than in the control group (P<0.05).

CONCLUSIONS

The presence of periodontitis in adjacent teeth can pose a risk to dental implants, potentially resulting in peri-implantitis. However, this was not observed for apical periodontitis. Within the limitations of this study, periodontal care is necessary to reduce the impact of periodontitis in adjacent teeth on osseointegrated implants.

Is routine antibiotic prophylaxis warranted in dental implant surgery to prevent early implant failure? - a systematic review

BACKGROUND

The question of whether antibiotic prophylaxis should be administered routinely for dental implant surgery is unresolved. Despite the lack of conclusive supportive evidence, antibiotics are often administered to reduce the risk of infection, which could lead to early implant failure. Increasing antibiotic resistance is a major concern and it is therefore important to reduce the overall use of antibiotics, including in dentistry. The aim of the present systematic review and meta-analysis was to evaluate the efficacy of preoperative antibiotics in preventing early implant failure, in overall healthy patients undergoing dental implant surgery.

METHODS

An electronic search was undertaken of PubMed (Medline), Web of Science and the Cochrane Library up to October 1st, 2023, to identify randomized clinical trials (RCTs). All RCTs comparing antibiotic prophylaxis with no antibiotics/placebo in overall healthy patients receiving dental implants were included. The primary outcome was patients with early implant failure. Risk of bias was assessed, data were extracted, a meta-analysis was done, and GRADE certainty-of-evidence ratings were determined. The risk ratio (RR), the risk difference (RD) and 95% confidence intervals (CI) were estimated.

RESULTS

After removal of duplicates, 1086 abstracts were screened, and 17 articles were reviewed in full text. Seven RCTs with moderate or low risk of bias and with a total of 1859 patients and 3014 implants were included in the meta-analysis. With reference to early implant failure at patient level, the meta-analysis failed to disclose any statistically significant difference (RR: 0.66, 95% CI: 0.30-1.47) between antibiotic prophylaxis and a placebo. The risk difference was -0.007 (95% CI: -0.035-0.020) leading to a number needed to treat (NNT) of 143.

CONCLUSION

Antibiotic prophylaxis for dental implant surgery does not seem to have any substantial effect on early implant failure ( ). The results do not support routine antibiotic prophylaxis for dental implant surgery.

Dental implant considerations in patients with systemic diseases: An updated comprehensive review

BACKGROUND

Various medical conditions and the drugs used to treat them have been shown to impede or complicate dental implant surgery. It is crucial to carefully monitor the medical status and potential post-operative complications of patients with systemic diseases, particularly elderly patients, to minimize the risk of health complications that may arise.

AIM

The purpose of this study was to review the existing evidence on the viability of dental implants in patients with systemic diseases and to provide practical recommendations to achieve the best possible results in the corresponding patient population.

METHODS

The information for our study was compiled using data from PubMed, Scopus, Web of Science and Google Scholar databases and searched separately for each systemic disease included in our work until October 2023. An additional manual search was also performed to increase the search sensitivity. Only English-language publications were included and assessed according to titles, abstracts and full texts.

RESULTS

In total, 6784 studies were found. After checking for duplicates and full-text availability, screening for the inclusion criteria and manually searching reference lists, 570 articles remained to be considered in this study.

CONCLUSION

In treating patients with systemic conditions, the cost-benefit analysis should consider the patient's quality of life and expected lifespan. The success of dental implants depends heavily on ensuring appropriate maintenance therapy, ideal oral hygiene standards, no smoking and avoiding other risk factors. Indications and contraindications for dental implants in cases of systemic diseases are yet to be more understood; broader and hardcore research needs to be done for a guideline foundation.

Survival rate of implants performed at sites of previously failed implants and factors associated with failure: A retrospective investigation

Background/purpose

Although reimplantation is currently a common treatment procedure, little information on reimplantation success or failure is available in the literature. The purpose of the present investigation was to evaluate the survival rate of dental implants that were performed in sites of previously failed implants and identify factors associated with the treatment outcome.

Materials and methods

This retrospective study is based on a cohort of patients rehabilitated with dental implants in the dental clinics of the universities contributing data to the BigMouth network between 2011 and 2022. Implants replacing a previously failed implant at the same site were included. Cases of first and second reimplantations were included Information regarding patients' characteristics including age, gender, ethnicity, race, tobacco use, and systemic medical conditions were extracted from patients' files.

Results

Records of 50,333 dental implants placed in 20,842 patients over a 12-year period were screened. Three hundred seventy implants placed in 284 patients were replaced by another implant at the same site. The cumulative survival rates of implants inserted for the first time was 98.6 %, for the first replacements was 96.1 % and for the second replacements was 91.7 %. First reimplants exhibited a significantly higher risk of failure than initial implantation (P < 0.001). Similarly, second reimplants demonstrated significantly greater risk of failure (P = 0.05) when compared to initial implants. No significant associations were detected between replaced implant failures with any of the patient related parameters evaluated (P > 0.05).

Conclusion

Within the limitations of the present study, dental implants replacing failed implants exhibited lower survival rates than the rates reported for the previous attempts of implant placement. No risk indicators for implant failure were identified. Additional factors should be examined in future studies.

Local risk factors for one-year dental implant loss and late loss in 287 failed implants caused by peri-implantitis or infection after prosthesis loading: a retrospective study

The purpose of this paper was to retrospectively assess the local factors that are likely to be associated with the risks for one-year dental implant loss.A retrospective study was designed and implemented. The sample consisted of patients who underwent an implant loss or removal caused by peri-implantitis or infection after prosthesis loading. The chi-squared test and generalised estimating equations (GEE) were used to explore the potential risk factors for one-year implant loss. A total of 279 patients with 287 failed implants were enrolled in this study. Immediate implant placement exhibited a 3.373 (95% CI: 1.652 to 6.886) significantly increased risk to experience one-year implant loss than early and late implant placement (p = 0.001). In addition, implants loaded during a healing period fewer than two months after implant placement were at 18.139 (95% CI: 8.925 to 36.866) significantly higher risk of one-year implant loss when compared with those that loaded within more than two months after implant placement (p < 0.001). Smokers were 1.866 (OR = 1.866,95% CI: 0.993 to 3.510) times as high risk for one-year implant loss as non-smokers, but there were no significant statistical differences (p = 0.053). Immediate implant placement and early implant loading were considered risk factors for one-year implant loss.

Strategies for Improving Impaired Osseointegration in Compromised Animal Models

Implant osseointegration is reduced in patients with systemic conditions that compromise bone quality, such as osteoporosis, disuse syndrome, and type 2 diabetes. Studies using rodent models designed to mimic these compromised conditions demonstrated reduced bone-to-implant contact (BIC) or a decline in bone mineral density. These adverse effects are a consequence of disrupted intercellular communication. A variety of approaches have been developed to compensate for the altered microenvironment inherent in compromised conditions, including the use of biologics and implant surface modification. Chemical and physical modification of surface properties at the microscale, mesoscale, and nanoscale levels to closely resemble the surface topography of osteoclast resorption pits found in bone has proven to be a highly effective strategy for improving implant osseointegration. The addition of hydrophilicity to the surface further enhances osteoblast response at the bone-implant interface. These surface modifications, applied either alone or in combination, improve osseointegration by increasing proliferation and osteoblastic differentiation of osteoprogenitor cells and enhancing angiogenesis while modulating osteoclast activity to achieve net new bone formation, although the specific effects vary with surface treatment. In addition to direct effects on surface-attached cells, the communication between bone marrow stromal cells and immunomodulatory cells is sensitive to these surface properties. This article reports on the advances in titanium surface modifications, alone and in combination with novel therapeutics in animal models of human disease affecting bone quality. It offers clinically translatable perspectives for clinicians to consider when using different surface modification strategies to improve long-term implant performance in compromised patients. This review supports the use of surface modifications, bioactive coatings, and localized therapeutics as pragmatic approaches to improve BIC and enhance osteogenic activity from both structural and molecular standpoints.

Enhancement of in vitro antibacterial activity and bioactivity of iodine-loaded titanium by micro-scale regulation using mixed-acid treatment

Postoperative infection and subsequent device loss are serious complications in the use of titanium dental implants and plates for jawbone reconstruction. We have previously reported that NaOH-CaCl2 -thermal-ICl3 -treated titanium (NaCaThIo) has a nano-scale surface and exhibits antibacterial activity against Staphylococcus aureus. The present study examined the surface properties of mixed-acid treated and then iodine-treated titanium (MA-NaCaThIo), and evaluated oral antibacterial activity and cytotoxicity compared with the results obtained with NaCaThIo. MA-NaCaThIo formed a surface layer with a nano-scale network structure having microscale irregularities, and both the thickness of the surface layer (1.49 ± 0.16 μm) and the average surface roughness (0.35 ± 0.03 μm) were significantly higher than those of NaCaThIo. Furthermore, MA-NaCaThIo maintained high hydrophilicity with a contact angle of 7.5 ± 1.7° even after 4 weeks, as well as improved apatite formation, iodine ion release, and antibacterial activity against Prevotella intermedia compared to NaCaThIo. Cell culture test revealed that MA-NaCaThIo exhibited no cytotoxicity against MG-63 and Vero cells, while increased cell proliferation, ALP activity and mineralization of MG-63 compared to NaCaThIo. This treated titanium is expected to be useful for the development of next-generation titanium devices having both bone-bonding and antibacterial properties.

Early Implant Failure: A Meta-Analysis of 7 Years of Experience

Background: The use of dental implant rehabilitation in the treatment of complete and partial edentulism has become an integral treatment today. This treatment is performed on healthy patients, but in some situations, also on those with associated general ailments. The presence of associated conditions increases the degree of difficulty of this type of treatment and tests the doctor's ability to manage the clinical case. The purpose of the study was to perform a meta-analysis of dental implants inserted over seven years and evaluate early implant failure in correspondence with age, sex, region of insertion, type of implant, and general state of health. Methods: A retrospective study was performed over 7 years of experience. For the study, 213 patients who fit the established inclusion criteria were selected. Patients were grouped taking into account age, sex, the type of implant used, and general associated conditions. The collected data were analyzed using IBM SPSS STATISTICS 25.0 for windows Results: There were no highlighted situations in which the rejection of the dental implant occurred 10 days postoperatively or later during the healing period. Conclusions: Our results confirm and strengthen the existing data in the specialized literature, especially those related to the loss of implants in patients with associated general diseases.

Involvement of interlukin-17A (IL-17A) gene polymorphism and interlukin-23 (IL-23) level in the development of peri-implantitis

BACKGROUND

Dental implantation has been practiced since ancient times and has gone through several stages. Dentists use dental implants to support dental prostheses such as crowns, bridges, dentures, face prostheses, or as an orthodontic anchor. Thus, the purpose of this study is to detect the role of the immune-genetic variation of IL-17A and related inflammatory cytokine (IL-23) in the initiation and progress of peri implantitis.

MATERIAL AND METHODS

This cross-sectional study included 80 subjects (15 peri-implantitis patients, 35 successful implants, and 30 healthy controls); their mean age was (43.91 ± 11.33) years. Blood samples and Peri-implant sulcus fluid (PISF) were collected from all subjects (patients with peri-implantitis, successful implants, and healthy controls) attending the Department of Oral and Maxillofacial Surgery in the Dental College Teaching Hospital, Baghdad University, Baghdad, Iraq. The blood sample detects gene polymorphisms in interleukin-17A by a polymerase chain reaction (PCR). An enzyme-linked immunosorbent assay (ELISA) was carried out to estimate the Peri-implant sulcus fluid (PISF) levels of interleukin-23.

RESULT

The current study revealed an obvious significant elevation in the mean level of interleukin-23 in the peri-implantitis patient's group more than its level in the successful implant and control groups (P < 0.05). In addition, the result showed that A/A genotype is associated significantly with peri-implantitis OR (95%confidence interval) =6.9 (1.7121 to 27.4638) folds increase risk of peri-implantitis) (p = 0.0065), while G/A genotype had OR 4.9 (0.9539-24.9394) folds increased risk of peri-implantitis, (p = 0.0572). But it was not statistically significant and G/G genotype had a one-fold increase risk of peri-implantitis.

CONCLUSION

The increased level of inflammatory cytokine (interleukin-23) might add to the systemic inflammatory burden a predisposing factor, which may lead to impaired osseointegration and subsequent bone loss or implant failure. In addition, IL-17A gene polymorphism may play a role in peri-implant disease susceptibility, especially in persons carrying the rs2275913 A allele at a higher risk of developing peri-implantitits as compared with those carrying the G allele.

A Study of the Associated Risk Factors for Early Failure and the Effect of Photofunctionalisation in Full-Arch Immediate Loading Treatment Based on the All-on-Four Concept

Early implant failure occurring within 1 year after implantation has been attributed to various factors. Particularly, early failure can lead to challenges in maintaining a full-arch prosthetic device, necessitating prompt intervention, including reoperation. This study aimed to retrospectively examine implant- and patient-related factors and the effects of photofunctionalisation associated with early failure in patients who underwent treatment using the all-on-four concept in both the maxilla and mandible. We conducted this retrospective study comprising 561 patients with 2364 implants who underwent implant-supported immediate loading with fixed full-arch rehabilitation using the all-on-four concept. We aimed to assess the survival rate within 1 year after implantation and determine the risk factors influencing early failure. The 1-year survival rates after implantation were 97.1% (patient level) and 98.9% (implant level) for the maxilla and 98.5% (patient level) and 99.6% (implant level) for the mandible. There was a significant difference in the implant-level survival rates between the maxilla and mandible, with a lower rate in the maxilla (p = 0.043). The risk factors associated with early implant failure according to the all-on-four concept included the maxilla (implant level) and smoking (patient level). We could not find a significant effect of photofunctionalisation on early failure (p = 0.25) following this treatment protocol.

Outcomes that may affect implant and prosthesis survival and complications in maxillary fixed prosthesis supported by four or six implants: A systematic review and meta-analysis

Objective

To investigate whether the clinical and radiographical outcomes are affected when four or six implants support the maxillary fixed complete denture (FCD).

Materials and methods

This study was registered on PROSPERO (CRD42021226432) and followed the PRISMA guidelines. The focused PICO question was, "For an edentulous maxillary patient rehabilitated with an implant-supported fixed prosthesis, do the clinical and radiographical outcomes differ when four or six implants support the prosthesis ". A thorough search of the relevant studies was designed and performed electronically. The survival rate of implant and prosthesis, marginal bone loss, and complications (mechanical and biological) were the primary outcomes, whereas implant distribution and using the surgical guide, follow-up, and framework material were evaluated as secondary outcomes.

Results

Out of 1099 articles initially retrieved, 53 clearly stated the outcomes of interest and were included in this study. There were no significant differences in implant and prosthesis survival, technical/mechanical complications, and biological complications between the 4-implant group (4-IG) and the 6-implant group (6-IG). However, marginal bone loss (MBL) was significantly higher in the 4-IG (p < 0.01). The surgical guide and follow-up period did not significantly affect implant/prosthesis survival. Additionally, using the CAD/CAM milled framework and anteroposterior implant distribution were associated with significantly higher implant survival in the 6-IG (p < 0.01).

Conclusion

The findings of this study indicated that having a greater number of implants, as seen in the 6-implant group, can lead to a decrease in technical and biological complications and reduce marginal bone loss. It is worth noting that factors such as using CAD/CAM frameworks and the anteroposterior distribution of implants were recognized as important in improving implant survival rates when more implants are present.

Biomechanical performance of dental implants inserted in different mandible locations and at different angles: A finite element study

STATEMENT OF PROBLEM

Accurate implant placement is essential for the success of dental implants. This placement influences osseointegration and occlusal forces. The freehand technique, despite its cost-effectiveness and time efficiency, may result in significant angular deviations compared with guided implantation, but the effect of angular deviations on the stress-strain state of peri-implant bone is unclear.

PURPOSE

The purpose of this finite element analysis (FEA) study was to examine the effects of angular deviations on stress-strain states in peri-implant bone.

MATERIAL AND METHODS

Computational modeling was used to investigate 4 different configurations of dental implant positions, each with 3 angles of insertion. The model was developed using computed tomography images, and typical mastication forces were considered. Strains were analyzed using the mechanostat hypothesis.

RESULTS

The location of the implant had a significant impact on bone strain intensity. An angular deviation of ±5 degrees from the planned inclination did not significantly affect cancellous bone strains, which primarily support the implant. However, it had a substantial effect on strains in the cortical bone near the implant. Such deviations also significantly influenced implant stresses, especially when the support from the cortical bone was uneven or poorly localized.

CONCLUSIONS

In extreme situations, angular deviations can lead to overstraining the cortical bone, risking implant failure from unfavorable interaction with the implant. Accurate implant placement is essential to mitigate these risks.

Mesenchymal stem cells and dental implant osseointegration during aging: from mechanisms to therapy

Dental implants are widely used to replace missing teeth, providing patients with unparalleled levels of effectiveness, convenience, and affordability. The biological basis for the clinical success of dental implants is osseointegration. Bone aging is a high-risk factor for the reduced osseointegration and survival rates of dental implants. In aged individuals, mesenchymal stem cells (MSCs) in the bone marrow show imbalanced differentiation with a reduction in osteogenesis and an increase in adipogenesis. This leads to impaired osseointegration and implant failure. This review focuses on the molecular mechanisms underlying the dysfunctional differentiation of aged MSCs, which primarily include autophagy, transcription factors, extracellular vesicle secretion, signaling pathways, epigenetic modifications, microRNAs, and oxidative stress. Furthermore, this review addresses the pathological changes in MSCs that affect osseointegration and discusses potential therapeutic interventions to enhance osseointegration by manipulating the mechanisms underlying MSC aging.

Clinical Impact on Dental Implant Survival in Patients Taking Antiresorptive Medications: A Systematic Review and Meta-Analysis

Dental implants are a predictable option to replace missing teeth. Patients on antiresorptive medications used to treat disorders associated with bone resorption may need dental implants to replace missing teeth. The data on implant failure in patients on antiresorptive medication requiring dental implants, is conflicting and limited. This systematic review aims to investigate if antiresorptive medications have any clinical impact on dental implant survival. Electronic databases were searched until May 2020. The focus question (PICOS): Participants: humans, Interventions: implant placement surgery in patients on antiresorptive medication, Comparisons: patients on antiresorptive medication vs control (patients not on antiresorptive medication), Outcomes: implant survival, and Study design: clinical studies. The protocol of this systematic review was registered in PROSPERO (CRD42020209083). Fourteen nonrandomized studies were selected for data extraction and risk of bias assessment using the ROBINS-1 tool. Only studies with a control were included for the meta-analysis, 8 articles were included in the meta-analysis using implant-level data, and 5 articles were included in the meta-analysis using patient-level data. There was no statistical significance between the 2 groups at the patient level based on 265 patients. However, there was a statistically significant difference at the implant level based on 2697 implants. Therefore, antiresorptive medications, mainly bisphosphonates (BPs), may significantly contribute to implant failure. Antiresorptive medications, especially BPs may reduce implant survival and impair the osseointegration of dental implants. Failed implants in patients on BPs may not lead to osteonecrosis and may be replaced with success.

Risk factors contributing to early implant failure following sinus augmentation: A study of a challenging cohort

BACKGROUND

Sinus augmentation has become a more predictable and successful procedure as the knowledge of its indications and complications increased. However, knowledge of risk factors leading to early implant failure (EIF) among challenging systemic and local conditions is insufficient.

OBJECTIVES

The present study aims to assess risk factors for EIF following sinus augmentation in a challenging cohort.

METHODS

A retrospective cohort study conducted during a period of 8 years in a tertiary referral centre providing surgical and dental health care. Implant and patient variables including age, ASA (American Society of Anesthesiology) physical status classification, smoking, residual alveolar bone, type of anaesthesia and EIF were collected.

RESULTS

Cohort was comprised of 751 implants placed in 271 individuals. EIF rates at the implant and patient level were 6.3% and 12.5%, respectively. EIF was found to be higher among smokers (patient level: χ2 (1) = 8.74, p = .003), ASA 2 physical classification patients (patient level: χ2 (2) = 6.75, p = .03), sinuses augmented under general anaesthesia (patient level: χ2 (1)=8.97, p = .003), higher bone gain (implant level: W = 12 350, p = .004), lower residual alveolar bone height (implant level: W = 13 837, p = .001) and multiple implantations (patient level: W = 3016.5, p = 0.01). However, other variables such as age, gender, collagen membrane and implant's dimensions did not reach significance.

CONCLUSIONS

Within the limits of the study, we can conclude that smoking, ASA 2 physical status classification, general anaesthesia, low residual alveolar bone height and numerous implants are risk factors for EIF following sinus augmentation in challenging cohorts.

COVID-19 as a factor associated with early dental implant failures: A retrospective analysis

OBJECTIVES

To analyze the effect of COVID-19 on early implant failures and identify potential risk factors for early implant failure, concerning patient- and implant-related factors.

MATERIALS AND METHODS

This retrospective study is based on 1228 patients who received 4841 implants between March 11, 2020, and April 01, 2022, at Erciyes University Faculty of Dentistry. COVID-19, age and gender of patients, smoking, diabetes, irradiation, chemotherapy, osteoporosis, the implant system, location, and characteristics of implants were recorded. At the implant level, univariate and multivariate generalized estimating equation (GEE) logistic regression was used to examine the effect of explanatory variables on early implant failure.

RESULTS

The early implant failure rate was 3.1% at the implant level and 10.4% at the patient level. Smokers showed a significantly higher incidence of early implant failures compared to nonsmokers. (odds ratio (OR; 95% CI): 2.140 (1.438-3.184); p < 0.001). Short implants (≤8 mm) had a higher risk of early implant failure than long implants (≥12 mm) (OR (95% CI): 2.089 (1.290-3.382); p = 0.003).

CONCLUSIONS

COVID-19 had no significant effect on early implant failure. Smoking and short implants were associated with a higher risk for early implant failures.

Five-year outcomes of immediate implant placement for mandibular molars with and without chronic apical periodontitis: A retrospective study

BACKGROUND

Most physicians consider molars with chronic apical periodontitis (CAP) lesions as contraindications for immediate implant placement. At the patient’s request, we perform immediate implant placement of the mandibular molars with CAP in clinical practice.

AIM

To retrospectively analyze and compare the 5-year outcomes of immediate implant placement of the mandibular molars with CAP and those without obvious inflammation.

METHODS

The clinical data of patients with immediate implant placement of the mandibular molars in the Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, from June 2015 to June 2017 were collected. The patients were divided into CAP (n = 52) and no-CAP (n = 45) groups. Changes in bone mineral density and bone mass around implants were analyzed 5 years after implant restoration.

RESULTS

At 5 years after implantation, the peri-implant bone mineral density was 528.2 ± 78.8 Hounsfield unit (HU) in the CAP group and 562.6 ± 82.9 HU in the no-CAP group (P = 0.126). Marginal bone resorption around implants did not differ significantly between the two groups, including buccal (P = 0.268) or lingual (P = 0.526) resorption in the vertical direction or buccal (P = 0.428) or lingual (P = 0.560) resorption in the horizontal direction. Changes in the peri-implant jump space did not differ significantly between the two groups, including the buccal (P = 0.247) or lingual (P = 0.604) space in the vertical direction or buccal (P = 0.527) or lingual (P = 0.707) space in the horizontal direction. The gray value of cone-beam computed tomography measured using Image J software can reflect the bone mineral density. In the CAP area, the gray values of the bone tissue immediately and 5 years after implant placement differed significantly from those of the surrounding bone tissue (P < 0.01).

CONCLUSION

The results of this study suggest that immediate implant placement of the mandibular molars with CAP can achieve satisfactory 5-year clinical results, without significant differences in the complications, survival rate, or bone tissue condition from the no-CAP mandibular molars.

Five-year outcomes of immediate implant placement for mandibular molars with and without chronic apical periodontitis: A retrospective study

BACKGROUND

Most physicians consider molars with chronic apical periodontitis (CAP) lesions as contraindications for immediate implant placement. At the patient's request, we perform immediate implant placement of the mandibular molars with CAP in clinical practice.

AIM

To retrospectively analyze and compare the 5-year outcomes of immediate implant placement of the mandibular molars with CAP and those without obvious inflammation.

METHODS

The clinical data of patients with immediate implant placement of the mandibular molars in the Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, from June 2015 to June 2017 were collected. The patients were divided into CAP (n = 52) and no-CAP (n = 45) groups. Changes in bone mineral density and bone mass around implants were analyzed 5 years after implant restoration.

RESULTS

At 5 years after implantation, the peri-implant bone mineral density was 528.2 ± 78.8 Hounsfield unit (HU) in the CAP group and 562.6 ± 82.9 HU in the no-CAP group (P = 0.126). Marginal bone resorption around implants did not differ significantly between the two groups, including buccal (P = 0.268) or lingual (P = 0.526) resorption in the vertical direction or buccal (P = 0.428) or lingual (P = 0.560) resorption in the horizontal direction. Changes in the peri-implant jump space did not differ significantly between the two groups, including the buccal (P = 0.247) or lingual (P = 0.604) space in the vertical direction or buccal (P = 0.527) or lingual (P = 0.707) space in the horizontal direction. The gray value of cone-beam computed tomography measured using Image J software can reflect the bone mineral density. In the CAP area, the gray values of the bone tissue immediately and 5 years after implant placement differed significantly from those of the surrounding bone tissue (P < 0.01).

CONCLUSION

The results of this study suggest that immediate implant placement of the mandibular molars with CAP can achieve satisfactory 5-year clinical results, without significant differences in the complications, survival rate, or bone tissue condition from the no-CAP mandibular molars.

Avoiding implant-related complications in medically compromised patients with or without unhealthy lifestyle/Elevated oxidative stress

Increased human life expectancy broadens the alternatives for missing teeth and played a role in the widespread use of dental implants and related augmentation procedures for the aging population. Though, many of these patients may have one or more diseases. These systemic conditions may directly lead to surgical complications, compromise implant/bone healing, or influence long-term peri-implant health and its response to biologic nuisances. Offering patients credible expectations regarding intra- and postoperative complications and therapeutic prognosis is an ethical and legal obligation. Clear identification of potential types of adverse effects, complications, or errors is important for decision-making processes as they may be related to different local, systemic, and technical aspects. Therefore, the present review structures the underlying biological mechanisms, clinical evidence, and clinical recommendations for the most common systemic risk factors for implant-related complications.

The Effect of Hyperlipidemia on Peri-implant Health: A Clinical and Radiographical Prospective Study

High levels of cholesterol and triglycerides may have a negative effect on the immune system and bone health, leading to lower bone mineral density, an increased risk of osteoporosis, and bone fractures, and could therefore also be related to a significant worsening of peri-implant health. The purpose of the following study was to evaluate whether the altered lipid profile in patients who undergo implant insertion surgery represents a prognostic factor capable of influencing clinical outcomes. This prospective observational study was conducted on 93 subjects; patients were required to have taken blood tests to obtain triglycerides (TG), total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels prior to the surgical procedure to classify them according to current American Heart Association guidelines. The outcomes considered were marginal bone loss (MBL) 3 years after implant placement, full-mouth plaque score (FMPS), and full-mouth bleeding score (FMBS) 3 years after surgery. A statistically significant correlation was found between hypertriglyceridemia and MBL as well as between total cholesterol and MBL. There is no statistically significant correlation between the variables analyzed and the secondary outcomes 3 years after implant placement. Peri-implant marginal bone loss may be influenced by hyperlipidemia. However, further studies are needed, with larger samples and more extensive follow-ups, to confirm these results.

Impact of Implant Diameter on the Early Survival Rate of Dental Implants in the Saudi Population: A One-Year Retrospective Study

Introduction The use of dental implants provides a revolutionary solution to the problem of missing teeth in the oral cavity. The aim of this study was to assess the early implant survival rate in relation to implant diameter and site of placement. Methods The data were collected from 186 patients treated between January 2019 and June 2021. All the implants were evaluated and restored after three months of implant placement. The early implant survival was calculated for different implant diameters with the odds ratio (OR). Results A total of 373 implants were placed. Implants were placed in the following areas: upper posterior area (UPA), n = 123, upper anterior area (UAA), n = 49, lower posterior area (LPA), n = 184, and lower anterior area (LAA), n = 17. Implants of the following diameters were placed: 3.5 mm (n = 129), 4.3 mm (n = 166), and 5 mm (n = 78). The overall early survival rate was 97.32% after three months of placement. The highest early survival rate was at LAA (100%) and the lowest early survival rate was at UAA (95.9%). The implants 5 mm in diameter had the highest early survival rate (98.72%), while the implants 3.5 mm in diameter had the lowest early survival rate (94.57%). The ORs of the early implant survival were 4.7 [95% confidence interval (CI): 0.96-23.05)] and 4.42 (95% CI: 0.53-36.61) for the 4.3 mm and 5 mm implants, respectively, with no statistical significance. Conclusions The implants placed in the oral cavity had acceptable survival rates regardless of implant diameter or site of placement.

Comparative Efficacy of Different Amoxicillin Dosing Regimens in Preventing Early Implant Failure—A Systematic Review with Network Meta-Analysis

This systematic review and network meta-analysis aimed to assess the comparative efficacy and safety of antibiotics to prevent early implant failure in patients undergoing dental implant surgery. Methods: The review was registered in PROSPERO [CRD42022319385]. A search was conducted for trials published in Medline, Cochrane, PubMed, and Scopus. A network meta-analysis was performed on the data from randomized controlled trials. Agents were ranked according to their effectiveness based on outcomes (implant failure, prosthetic failure, postsurgical complications, and adverse effects) using the surface under the cumulative ranking [SUCRA]. Results: A total of 15 articles were included in the quantitative analysis. When compared to the placebo, 2 g of amoxicillin given 1 h preoperatively (RR = 0.42 (95%CI: 0.27, 0.67)), 2 g of amoxicillin given 1 h preoperatively with postoperative 500 mg thrice for 5 days (RR = 0.36 (95%CI: 0.15, 0.87)), and post-operative amoxicillin with clavulanic acid 625 mg 3 times daily for 5 days (RR = 0.38 (95%CI: 0.16, 0.90)) were effective in reducing early implant failures. In addition, 2 g of amoxicillin given 1 h preoperatively (RR = 0.42 (95%CI: 0.25, 0.73)) was the only protocol that was significant in the pairwise meta-analysis results. However, sensitivity analysis, which excluded trials with a high risk of bias, showed that none of the protocols were statistically significant in reducing early implant failure. Conclusions: A single 2 g dose of preoperative amoxicillin significantly reduces early implant failure in healthy individuals. More high-quality trials are required to establish this recommendation, as the quality of this evidence is weak.

The effect of preoperative clindamycin in reducing early oral implant failure: a randomised placebo-controlled clinical trial

OBJECTIVES

To assess the effect of preoperative oral clindamycin in reducing early implant failure in healthy adults undergoing conventional implant placement.

MATERIALS AND METHODS

We conducted a prospective, randomised, double-blind, placebo-controlled clinical trial in accordance with the ethical principles and Consolidated Standards of Reporting Trials statement. We included healthy adults who underwent a single oral implant without previous infection of the surgical bed or the need for bone grafting. They were randomly treated with a single dose of oral clindamycin (600 mg) 1 h before surgery or a placebo. All surgical procedures were performed by one surgeon. A single trained observer evaluated all patients on postoperative days 1, 7, 14, 28, and 56. Early dental implant failure was defined as the loss or removal of an implant for any reason. We recorded the clinical, radiological, and surgical variables, adverse events, and postoperative complications. The study outcomes were statistically analysed to evaluate differences between the groups. Furthermore, we calculated the number required to treat or harm (NNT/NNH).

RESULTS

Both the control group and clindamycin group had 31 patients each. Two implant failures occurred in the clindamycin group (NNH = 15, p = 0.246). Three patients had postoperative infections, namely two placebo-treated and one clindamycin-treated, which failed (relative risk: 0.5, CI: 0.05-5.23, absolute risk reduction = 0.03, confidence interval: - 0.07-0.13, NNT = 31, CI: 7.2-∞, and p = 0.5). One clindamycin-treated patient experienced gastrointestinal disturbances and diarrhoea.

CONCLUSIONS

Preoperative clindamycin administration during oral implant surgery in healthy adults may not reduce implant failure or post-surgical-complications.

CLINICAL RELEVANCE

Oral clindamycin is not efficacy.

TRIAL REGISTRATION

The present trial was registered (EudraCT number: 2017-002,168-42). It was approved by the Committee for the Ethics of Research with Medicines of Euskadi (CEIm-E) on 31 October 2018 (internal code number: 201862) and the Spanish Agency of Medicines and Medical Devices (AEMPS) on 18 December 2018.

Association of interleukin-1, interleukin-6, collagen type I alpha 1, and osteocalcin gene polymorphisms with early crestal bone loss around submerged dental implants: A nested case control study

STATEMENT OF PROBLEM

The reason for variations in peri-implant early crestal bone loss is unclear but may be due to genetic differences among individuals.

PURPOSE

The purpose of this nested case control study was to investigate the association of single-nucleotide polymorphisms of interleukin-1, interleukin-6, collagen type I alpha1, and osteocalcin genes to early crestal bone loss around submerged dental implants.

MATERIAL AND METHODS

Dental implants were placed in the mandibular posterior region (single edentulous space) of 135 participants selected according to predetermined selection criteria. Bone mineral density measurement by using dual energy X-ray absorptiometry, cone beam computed tomography scans at the baseline and after 6 months, and interleukin-1A-889 A/G (rs1800587), interleukin-1B-511 G/A (rs16944), interleukin-1B+3954 (rs1143634), interleukin-6-572 C/G (rs1800796), collagen type I alpha1 A/C (rs1800012), and osteocalcin C/T (rs1800247) genotyping were performed in all participants. Early crestal bone loss measured around dental implants was used to group participants into clinically significant bone loss (BL)>0.5 mm and clinically nonsignificant bone loss (NBL)≤0.5 mm. Early crestal bone loss was calculated as the mean of the difference of bone levels at the baseline and bone levels after 6 months as measured with cone beam computed tomography scans. The obtained data for basic characteristics, early crestal bone loss, and genotyping were tabulated and compared by using a statistical software program (α=.05).

RESULTS

AA genotype and the A allele frequency of interleukin-1B-511 and GG genotype and the G allele frequency of interleukin-6-572 were significantly higher in BL than in NBL (P<.05). Multiple logistic analysis suggested that interleukin-1B-511 AA/GG+AG and interleukin-6-572 GG/CC+CG genotype expression were significantly associated with early crestal bone loss (AA/GG+AG; P=.014, GG/CC+CG; P=.047) around dental implants. Other risk factors were not significantly different (P>.05).

CONCLUSIONS

Of the genes studied, individuals with interleukin-1B-511 AA (rs16944) or interleukin-6-572 GG (rs1800796) genotype had higher susceptibility to early crestal bone loss around dental implants.

Implant Site Changes in Three Different Clinical Approaches: Orthodontic Extrusion, Regenerative Surgery and Spontaneous Healing after Extraction: A Systematic Review

Both surgical and non-surgical techniques are employed for implant site development. However, the efficacy of these methods has not been thoroughly evaluated and compared. This systematic review aims to compare the biologic, functional and esthetic outcomes of three different approaches before implant placement in both the maxillary and mandibular arches: orthodontic extrusion, regenerative surgery and spontaneous healing after extraction. The systematic research of articles was conducted up to January 2020 in Medline, Scopus and the Cochrane Library databases. Studies were selected in a three-stage process according to the title, the abstract and the inclusion criteria. The methodological quality and the risk of bias of the included studies were evaluated using ROBINS-I tools for non-randomized studies, Rob 2.0 for RCT. Quality evaluation of case reports was performed using CARE guidelines. Through the digital search, 1607 articles were identified, and 25 of them were included in the systematic review. The qualitative evaluation showed a good methodological quality for RCT, sufficient for non-randomized studies and poor for case reports. Based on the available results, both orthodontic extrusion and regenerative surgery allowed the development of the implant site with satisfying esthetic and functional outcomes. Studies about the spontaneous healing of the extraction socket showed resorption of the edentulous ridge, which complicated the implant insertion. No study referred to failures or severe complications. Most of the studies reported only qualitative results. The present systematic review demonstrated that there is a substantial lack of data and evidence to determine which of the presented methods is better for developing a future implant site. Both surgical and non-surgical procedures appear effective in the regeneration of hard tissue, whereas not all the techniques can improve soft tissue volume, too. The orthodontic technique simultaneously enhances both hard and soft tissue.

Dental Implant Survival after Postoperative Infection

Purpose

Early postoperative infection can lead to dental implant failure. This study aimed to evaluate the frequency of failed and survived implants after acute postoperative infection and the related factors.

Materials and Methods

This cross-sectional cohort evaluated early infection after dental implant surgery. The study variables included the site of implant placement, age and gender of patients, bone augmentation, postoperative antibiotic therapy, smoking, and time of infection occurrence or diagnosis. Failed and survived implants were the outcome of the study. The patients were studied in 2 groups of survived implants (group 1) and failed implants (group 2).

Results

Thirty-four (3.46%) out of 980 patients developed a postoperative infection following implant placement, which included 25 males and 9 females. Ten implants (29.4%) survived (group 1), and 24 implants (70.6%) failed (group 2). There were significant differences between the 2 groups regarding the number of smoker patients, fresh socket or delayed implant placement, patients who received bone graft, and the meantime of diagnosis (P < 0.05). Regarding the covariates, the Kaplan-Meier analysis showed that the risk of implant failure in patients who did not receive postoperative antibiotic therapy increased by 1.1 times (hazard ratio) when infection occurred four days after surgery. In patients who received postoperative antibiotics, the risk of failure increased when infection occurred after 6 days in smokers and after 9 days in non-smokers.

Conclusion

Considering the study results, it seems that smoking, early infection, fresh socket placement, and placement of implants along with bone substitutes may increase the failure rate after acute infection in dental implant placement.

Survival Rates and Factors Affecting the Outcome Following Immediate and Delayed Implant Placement: A Retrospective Study

Background: Immediate implant placement into extraction sockets has become a widely acceptable treatment option to decrease treatment time and enhance esthetics. The objectives of this study were to assess and compare the survival rates of immediate and delayed implant treatment as well as to investigate the effect of patient- and site-related variables on the treatment outcome in a large-scale population-based study. Methods: Dental records of patients who received implant therapy were retrieved from the electronic records of the University of Minnesota School of Dentistry. Demographic characteristics, dental insurance status, socioeconomic status as well as medical history and tobacco use were recorded. The treatment outcome was included as a binary variable (survival/failure). Time to failure (date of procedure to date of visit with failure) was compared between immediate and delayed implant treatment in Cox regression models. Kaplan−Meier plots for the survival of both treatment modalities were created. Patient-sites without failure were censored at the last follow-up visit. Results: A total of 4519 records of implants were included. The sample mean age was 60.27 years and included 50.7% males and 12.9% tobacco users. High socioeconomic status was characterized for 82.3% of the included population and 63.0% of them were self-payers. Immediate implants were significantly more frequently placed in the maxillary arch (p < 0.001) than in the mandible. Tobacco users received more often a delayed rather than an immediate implant placement (p = 0.001). The survival rate analysis revealed there were no significant differences between immediate and delayed implant placements (p = 0.48). The mean follow-up time was 32.27 months during which 1.5% immediate and 1.1% delayed implants were removed. The estimated mean survival time for immediate implants was 68.90 months, while delayed implants placed in healed sockets showed a mean survival time of 75.11 months. A statistically significant association was found between gender (p = 0.03) and osteoporosis (p = 0.001) with treatment outcome. Conclusions: The placement of immediate implants achieved similarly high survival rates when compared to delayed implants placed in healed sites. Males and osteoporotic individuals showed significantly higher implant failure than females and non-osteoporotic patients. This study demonstrated that both immediate and delayed implant placements are sound options with predictable treatment outcome.

Manganese Oxide Nanozyme-Doped Diatom for Safe and Efficient Treatment of Peri-Implantitis

Peri-implantitis is a major cause of dental implant failure. Bacterial biofilm contamination on the implant induces surrounding bone resorption and soft tissue inflammation, leading to severe deterioration of oral health. However, conventional biofilm removal procedures, such as mechanical decontamination and antiseptic application, are not effective enough to induce reosseointegration on decontaminated implant surfaces. This is due to (1) incomplete decontamination of the biofilm from inaccessible areas and (2) physicochemical alteration of implant surfaces caused by decontamination procedures. Herein, a safe and effective therapeutic approach for peri-implantitis is developed, which involves decontamination of implant-bound biofilms using the kinetic energy of microsized oxygen bubbles generated from the catalytic reaction between hydrogen peroxide (H2O2) and manganese oxide (MnO2) nanozyme sheet-doped silica diatom microparticles (Diatom Microbubbler, DM). Rapidly moving microsized DM particles are able to penetrate narrow spaces between implant screws, exerting just the right amount of force to entirely destroy biofilms without harming the surrounding mucosa or implant surfaces, as opposed to conventional antiseptics such as chlorhexidine or 3% H2O2 when used alone. Consequently, decontamination with DM facilitates successful reosseointegration on the peri-implantitis-affected implant surface. In summary, our new DM-based therapeutic approach will become a promising alternative to resolve clinically challenging aspects of peri-implantitis.

Elagib M. Effectiveness of Different Chemotherapeutic Agents for Decontamination of Infected Dental Implant Surface: A Systematic Review

AIM

To evaluate the most effective chemotherapeutic agent for decontamination of infected dental implants.

MATERIAL AND METHODS

A systematic electronic literature search in MEDLINE (PubMed) and Google scholar between January 2010 to December 2021 was carried out by using the PRISMA guidelines. A total of five studies related to chemical decontamination of the dental implant were evaluated. The search strategy was based on the PICOS framework. Randomized controlled trials (RCT's) and cohort studies evaluating the effectiveness of different chemotherapeutic agents for the decontamination of dental implants were included in the study. The outcome variable examined was the most effective chemotherapeutic agent(s) for dental implant surface decontamination after comparing the chemotherapeutic agents used in the qualifying studies.

RESULT

Out of the basic database of 1564 records, 1380 articles were excluded due to irrelevance, unavailability, and repetition. Furthermore, 134 articles were excluded from 184 studies for various reasons. After further filtration, 13 studies were shortlisted. Two investigators (SSA and SA) appraised the quality of the selected studies using the risk of bias assessment tool. After excluding eight studies, five articles were finally included in the present systematic review.

CONCLUSION

The data reported for the efficacy of chemotherapeutic agents in cleaning contaminated titanium surfaces are scarce, thus it is not possible to draw a definite conclusion. However, chlorhexidine (CHX) (0.2%, 0.12%), citric acid (40%) and sodium hypochlorite (1%) are the most commonly used chemotherapeutic agents; amongst them, citric acid showed the highest potential for biofilm removal from the contaminated implant surface. All three agents [CHX (0.2%, 0.12%), citric acid (40%), and sodium hypochlorite (1%)] can be recommended as therapeutic agents along with their curbs.

Patients with Thyroid Disorder, a Contraindication for Dental Implants? A Systematic Review

The thyroid gland is composed of the thyroid follicles, considered to be the functional units of the thyroid gland. The synthesis of the thyroid hormones occurs in these follicles. Triiodothyronine (T3) and thyroxine (T4) are the thyroid hormones and affect metabolic processes all through the body. This systematic evaluation was performed to answer the following PICO question: “Can patients with thyroid disorders undergo dental implant rehabilitation with the same survival rate as patients without thyroid disorders?”. A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements to gather available and current evidence of thyroid disorders and its relationship with dental implants. The electronic search, in the PubMed and Cochrane databases, yielded 22 articles. Out of the 22 articles, only 11 fulfilled the inclusion criteria. Manual research of the reference list yielded no additional papers. According to the SORT criteria and answering our PICO question, level B can be established to conclude that patients with thyroid disorders can be rehabilitated with dental implants, with similar survival rates as patients without thyroid disorders. Papers with higher scientific evidence and bigger sample size should be carried out.

Dental implant failure rates in patients with self-reported allergy to penicillin

BACKGROUND

In a number of previous studies, patients with reported penicillin allergies have been documented to experience higher rates of dental implant failure than those who had not reported this allergy. The authors of this study aimed to determine whether an increased risk of implant failure is associated with patient-reported penicillin allergy and which antibiotic was administered.

METHODS AND MATERIALS

A retrospective study was conducted through chart review of patients who received dental implants at the New York University College of Dentistry. Participants were eligible if they received one or more dental implants at the College and provided at least 1 year of follow-up data.

RESULTS

The overall implant failure rate was 12.9%. The failure rate in patients who reported no allergy to penicillin and took amoxicillin was 8.4%, while the failure rate in the allergy-reporting group was 17.1% (adjusted OR = 2.22, 95% CI = 1.44-3.44). The failure rate in allergy-reporting patients who took Clindamycin was also higher than in those who took amoxicillin (19.9%; adjusted OR = 2.9, 95% CI = 1.77-4.47) or any antibiotic other than amoxicillin (20.9%; adjusted OR = 2.77, 95% CI = 1.77-4.32).

CONCLUSIONS

Significant findings included a lower implant failure rate in patients taking amoxicillin than in patients taking other antibiotics. There was a significant increase in early implant failure in allergy reporting patients.

Modification of implant surfaces to stimulate mesenchymal cell activation

BACKGROUND

The process of osteointegration, as key point has the activation of mesenchymal cells at implant-bone interspace, their differentiation into osteoblasts and connection between the implant surface and the surrounding bone.

MAIN TEXT

Implant surfaces composed by biocompatible, organism-friendly materials require changes in content and surface morphology; changes that may further stimulate mesenchymal cell activation. The way the implant surfaces are affected with advantages and disadvantages, that typically bring each methodology, is also the purpose of this study. The study is of review type, based on finding articles about implant surface modification, with the aim of promoting the mesenchymal cell activation, utilizing keyword combination.

CONCLUSIONS

Implant success beyond the human element of the practicioner and the protocol element of implant treatment, also relies on the application of the right type of implant, at the right implant site, in accordance with oral and individual health status of the patient. Implant success does not depend on type of "coating" material of the implants. Based at this physiological process, the success or implant failure is not a process depending on the type of selected implant, because types of synthetic or natural materials that promote osteointegration are relatively in large number.

A Systematic Analysis of the Available Human Clinical Studies of Dental Implant Failure in Patients with Inflammatory Bowel Disease

Background and objectives: The aim was to evaluate the current literature on the influence of inflammatory bowel disease (ulcerative colitis/Crohn’s disease) in dental implant osseointegration in human clinical studies. Materials and methods: This review was conducted under the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. PubMed, Scopus, and Web of Science databases were electronic screened to find relevant articles published until October 2021. The inclusion criteria consisted of human clinical studies that reported the use of dental implant in patients diagnosed with inflammatory bowel disease. Risk of bias was assessed according to The Strengthening the Reporting of Observational studies in Epidemiology criteria. Results: A total of 786 studies were identified from databases. Of these, six studies were included in the review and reported the use of implants in patients with Crohn’s disease. No articles were available for ulcerative colitis. Included articles indicated that Crohn’s disease may determine early and late implant failure. Besides Crohn’s disease, several patients presented associated risk factors and systemic disease that determined implant failure. Conclusions: The presence of clinical studies on the influence of IBD in implant therapy is low. When recommending an implant therapy to IBD patients, the multidisciplinary team should be aware of side effects and a close collaboration between members of this team is necessary. More data are needed to sustain the effect of IBD on implant therapy.

Etiology, occurrence, and consequences of implant loss

Implant therapy aims at providing the patient with a functional and esthetically pleasing rehabilitation in a long‐term perspective. The loss of an implant constitutes a major complication, which may have an impact on the treatment plan and/or jeopardize the longevity of the restoration. Implant loss may occur during the phase of osseointegration (early) or at a later time when the previously achieved osseointegration is lost (late). The present work evaluates the evidence on the occurrence of both events and discusses etiology, risk factors, and consequences.

Dental implants in patients suffering from autoimmune diseases: A systematic critical review

PURPOSE

This systematic review aimed to evaluate complications and survival rates of dental implants placed in patients suffering from autoimmune diseases.

MATERIALS AND METHODS

A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines (PRISMA), using Google scholar and PubMed electronic databases with a stop date of September 2021. The eligibility criteria included all full text human studies in the English language literature reporting on patients with autoimmune diseases treated with dental implants.

RESULTS

Fifty-five studies reporting on nine distinct autoimmune diseases were analyzed: 17 on Sjögren's syndrome (SS), 11 on oral lichen planus (OLP), 8 on Type 1 diabetes, 6 on rheumatoid arthritis (RA), 4 on systemic scleroderma (SSc), 3 on Crohn's disease (CD), 3 on systemic lupus erythematosus (SLE), 2 on mucous membrane pemphigoid (MMB) and 1 on pemphigus vulgaris (PV). Despite the heterogeneity and methodological limitations of most of the studies, results showed that dental implant survival rates were comparable to those reported in the general population. However, patients with secondary SS or erosive OLP were more susceptible to developing peri-mucositis and increased marginal bone loss.

CONCLUSION

This review suggested that dental implants may be considered as a safe and viable therapeutic option in the management of edentulous patients suffering from autoimmune diseases. Nevertheless, scrupulous maintenance of oral hygiene and long-term follow-up emerge as being the common determinants for uneventful dental implant treatment.

Effects of smoking on the bone alkaline phosphatase in peri-implant crevicular fluid and implant stability quotient around implants before loading

We aimed to examine the implant stability quotient (ISQ), alveolar bone level measurements (ABL), and bone alkaline phosphatase (BALP) in peri-implant crevicular fluid (PICF) around implants in smokers and non-smokers before loading in 3 months. 44 dental implants were placed into smoker and non-smoker patients equally. ISQ was measured at baseline and 3 months after surgery. The levels of PICF BALP and alveolar bone were measured. ISQ values significantly increased in smokers and non-smokers in the 3rd month (p < 0.05). ABL measurements were lower at 3 months compared to baseline in both groups (p < 0.05). Although ISQ and ABL values were higher in non-smokers than smokers at 3 months, the difference between the groups did not show any statistical significance. The PICF BALP levels in the 3rd month changed in both groups. But, these differences were insignificant. Although some of the measurements presented differences between the groups during the assessment periods, they were not indicative of the hazardous effects of smoking on bone healing around implants after surgery till functional loading in 3 months. However, smoking is an important factor to be considered for osseo-integration outcomes. Further studies are needed to clarify the influence of smoking on osseo-integration.

Evaluation of failed implants and reimplantation at sites of previous dental implant failure: survival rates and risk factors

Purpose

The purpose of this study was to evaluate failed implants and reimplantation survival and to identify the relative risk factors for implant re-failure.

Methods

Ninety-one dental implants were extracted between 2006 and 2020 at the National Health Insurance Service Ilsan Hospital, including 56 implants in the maxilla and 35 implants in the mandible that were removed from 77 patients. Patient information (e.g., age, sex, and systemic diseases) and surgical information (e.g., the date of surgery and location of the implants and bone grafts) were recorded. If an implant prosthesis was used, prosthesis information was also recorded.

Results

In total, 91 first-time failed dental implants in 77 patients were analyzed. Of them, 69 implants in 61 patients received reimplantation after failure. Sixteen patients (22 implants) refused reimplantation or received reimplantation at a different site. Eight of the 69 reimplants failed again. The 1-year survival rate of the 69 reimplants was 89.4%. Age at reimplantation and smoking significantly increased the risk of reimplantation failure. However, a history of taking anti-thrombotic agents showed a statistically significant negative association with reimplantation failure. Of the failed implants, 66% showed early failure and 34% showed late failure of the initial implantation. All 8 re-failed implants showed early failure. Only 3 of these 8 failed reimplants were re-tried and the second reimplants all survived.

Conclusions

The total survival rate of implants, which included reimplants and second reimplants was 99.2%, although the survival rate of the initial implantations was 96.3%. Previous failure did not affect the success of the next trial. Reimplantation failure was more strongly affected by patient factors than by implant factors. Therefore, each patient’s specific factors need to be meticulously controlled to achieve successful reimplantation.

Intraosseous Injection of Calcium Phosphate Polymer-Induced Liquid Precursor Increases Bone Density and Improves Early Implant Osseointegration in Ovariectomized Rats

PURPOSE

Osteoporosis, due to bone loss and structural deterioration, is a risk factor for dental implant failure, as it impedes initial stability and osseointegration. We aim to assess the effects of calcium phosphate polymer-induced liquid precursor (CaP-PILP) treatment, which significantly increases bone density and improves early implant osseointegration in ovariectomized rats.

METHODS

In this study, CaP-PILP was synthesized and characterized through TEM, FTIR and XRD. A rat model of osteoporosis was generated by ovariectomy. CaP-PILP or hydroxyapatite (HAP, negative control) was injected into the tibia, and the resulting changes in bone quality were determined. Further, implants were installed in the treated tibias, and implantation characteristics were assessed after 4 weeks.

RESULTS

The CaP-PILP group had superior bone repair. Importantly, CaP-PILP had excellent properties, similar to those of normal bone, in terms of implant osseointegration. In vivo experiment displayed that CaP-PILP group had better bone contact rate (65.97±3.176) than HAP and OVX groups. Meanwhile, a mound of mature and continuous new bone formed. Moreover, the values of BIC and BA showed no significant difference between the CaP-PILP group and the sham group.

CONCLUSION

In summary, CaP-PILP is a promising material for application in poor-quality bones to improve implant success rates in patients with osteoporosis. This research provides new perspectives on the application of nano-apatite materials in bone repair.

Influence of osteoporosis and mechanical loading on bone around osseointegrated dental implants: A rodent study

This study aimed to evaluate the influence of estrogen deficiency and mechanical loading on bone around osseointegrated dental implants in a rat jaw model. The maxillary right first molars of 36 rats were extracted. One week later, the rats were divided into an unloaded group and a loaded group; short head implants and long head implants were inserted respectively. Nine weeks after implantation, the rats were further subjected to ovariectomy (OVX) or sham surgery. All animals were euthanized 21 weeks after OVX. Micro-computed tomography, histological and histomorphometrical evaluation were undertaken. Systemic bone mineral density and bone volume fraction decreased in OVX groups compared with the sham controls. Histomorphometrical observation indicated that unloaded OVX group showed significantly damaged osseointegration and bone loss versus the loaded OVX group. Both the bone density (BD) inside the peri-implant grooves and the percentage of bone-to-implant contact (BIC) were lower in the OVX groups than in the sham-surgery groups, although mechanical loading increased the BIC and BD in the loaded OVX group compared with the unloaded OVX group. An increased number of positive cells for tartrate-resistant acid phosphatase was observed in the OVX groups versus the sham controls. The percentage of sclerostin-positive osteocytes was lower under loaded compared with unloaded conditions in both the OVX groups and the sham controls. In conclusion, estrogen deficiency could be a risk factor for the long-term stability of osseointegrated implants, while mechanical loading could attenuate the negative influence of estrogen deficiency on bone formation and osseointegration.