Short dental implants in reduced alveolar bone height: a review of the literature

Rehabilitation of Atrophied Maxillary Bones With Short-Splinted Implants in a Periodontitis Patient: A Six-Year Follow-Up Case Report

This case report aims to report the successful use of a short-splinted implant in a patient with a history of periodontal disease. Two implants were used to rehabilitate severe atrophied alveolar ridge with fixed prosthesis. Despite the left posterior ridge being weakened by maxillary sinus pneumatization and bone remodeling after tooth extraction, no bone grafts nor sinus osteotomy procedures were needed for the rehabilitation surgery. The report examines the use of Roxolid® SLActive® surface implants (Straumann Group, Basel, Switzerland) for the restoration of missing posterior teeth in the atrophied alveolar ridge. These implants offer improved mechanical properties that enhance their durability and dependability, which increase their survival rate. This case report demonstrates that the use of short-splinted implants can effectively reduce morbidity rates and the risk of implant failure. Additionally, the simplified rehabilitation surgery involving a short implant, when combined with proper surgical and prosthetic management, appears to be a viable treatment option that is both cost-effective and less time-consuming for rehabilitating atrophied maxillary ridges. It is important to emphasize that rigorous periodontal maintenance, which includes regular professional follow-ups and effective oral hygiene practices, is essential for achieving optimal health of both soft and hard oral tissues around dental implants.

Exploring Non-conventional Dental Implants Beyond Traditional Paradigms Part I: Bridging the Gap in Bone Deficiency Cases

Dental implants have revolutionized tooth replacement, offering a functional and aesthetically pleasing alternative to traditional dentures and bridges. While conventional implants, typically titanium screws placed into the jawbone, have become the gold standard, many studies explore non-conventional implant designs and materials to address specific challenges and patient needs. This series of literature reviews aimed to delve into non-conventional dental implants, examining their unique features and applications and the current state of evidence supporting their use. The short and mini dental implants represent a cutting-edge area of research within the field of implant dentistry. Its potential application in the management of cases with limited bone availability has emerged as a viable alternative to the use of bone augmentation procedures. To date, significant progress has been made in the field of dental implants, particularly with the introduction of short and mini dental implants in the management of cases with significant bone deficiency. However, it remains a remarkable challenge that continues to be actively researched.

The potential bone regeneration effects of leptin- and osteolectin-coated 3D-printed PCL scaffolds: anin vivostudy

This study investigated the effectiveness of bone regeneration upon the application of leptin and osteolectin to a three-dimensional (3D) printed poly(ϵ-caprolactone) (PCL) scaffold. A fused deposition modeling 3D bioprinter was used to fabricate scaffolds with a diameter of 4.5 mm, a height of 0.5 mm, and a pore size of 420-520 nm using PCL (molecular weight: 43 000). After amination of the scaffold surface for leptin and osteolectin adhesion, the experimental groups were divided into the PCL scaffold (control), the aminated PCL (PCL/Amine) scaffold, the leptin-coated PCL (PCL/Leptin) scaffold, and the osteolectin-coated PCL (PCL/Osteo) scaffold. Next, the water-soluble tetrazolium salt-1 (WST-1) assay was used to assess cell viability. All groups exhibited cell viability rates of >100%. Female 7-week-old Sprague-Dawley rats were used forin vivoexperiments. Calvarial defects were introduced on the rats' skulls using a 5.5 mm trephine bur. The rats were divided into the PCL (control), PCL/Leptin, and PCL/Osteo scaffold groups. The scaffolds were then inserted into the calvarial defect areas, and the rats were sacrificed after 8-weeks to analyze the defect area. Micro-CT analysis indicated that the leptin- and osteolectin-coated scaffolds exhibited significantly higher bone regeneration. Histological analysis revealed new bone and blood vessels in the calvarial defect area. These findings indicate that the 3D-printed PCL scaffold allows for patient-customized fabrication as well as the easy application of proteins like leptin and osteolectin. Moreover, leptin and osteolectin did not show cytotoxicity and exhibited higher bone regeneration potential than the existing scaffold.

Clinical Outcome of Immediate Loading UV-Photofunctionalized Implants in Patients with Completely Edentulous Mandible, Placed with Guided Surgery

Objectives

The purpose of this study was to evaluate clinical results of immediate loading UV-photofunctionalized dental implants placed using guided surgery in patients with completely edentulous mandible.

Material and Methods

In this study, 58 fully edentulous patients were treated with immediate loading implant-supported mandibular prostheses. All patients underwent a thorough clinical examination according to the generally accepted scheme; qualitative and quantitative parameters of the jaw bones patients were diagnosed with cone beam computerized tomography (CBCT). Surgical templates modeled in the 3 Shape software were made from biocompatible polymeric materials and provided with depth-calibrated drill sleeves for preparing osteotomies using a 3D printer (Stratasys). Before short implant placement, ultraviolet functionalization of implant surfaces was performed by UV Activator YWJ-QSY001 (Foshan, Wenjian Medikal Enstriman) in the device for 20 s. After flapless surgery, implant sockets were prepared with guided surgery and implants were placed through the sleeves of the surgical template tightening torque of 35-45 Ncm. An implant-supported temporary prosthesis made of acrylic resin was installed 6 h after implantation. Final dental prosthetics was performed 2 months after implant placement.The patients had 128 short (length 5-6 mm, diameters 4,5-5 mm) and 256 implants with length greater than 10 mm in bone segments with sufficient bone parameters. The following parameters were assessed: implant success, prosthetics survival and changes in peri-implant marginal bone loss (MBL).

Results

During a clinical examination, no serious biological or prosthetic complications have been reported. The esthetic result evaluated from patients was excellent. The mean ISQ of short implants was 69.2 ± 8 for primary stability at implant placement and 73.6 ± 4 ISQ after 3 months. The mean of implants with length greater than 10 mm was 71,2ISQ at implant placement, respectively, and 75,6 ISQ after 3 months. After 3 months of prosthetic loading for short implants marginal bone loss (MBL) 0.74 mm, after 1 year of MBL 11.21 mm, after 5 years of MBL 1,37 mm, for implants with length greater than 10 mm after 3 months of MBL 0.72 mm, after 1 year of MBL 1.19 mm and after 5 years of MBL 1.35. There was no statistically significant difference in clinical indices between short and standard implants. After 5 years of follow-up, stable levels of bone tissue around the implants and healthy tissues around the implants were recorded, and postoperative occlusal function was favorable. The success rates of the short implants in maxilla were 95.5%, and the success rates of the short implants in mandible were 98.7%. The success rates of the implants with length greater than 10 mm in maxilla were 97.8%, and the success rates of the implants with length greater than 10 mm in mandible were 98.8%.

Conclusion

Computer-guided implant surgery and immediate loading of UV-photofunctionalized implants in patients with completely edentulous mandible are a predictable and effective method with a minimum rehabilitation period.

Design and ex vivo characterization of narrow implants with custom piezo-activated osteotomy for patients with substantial bone loss

OBJECTIVE

Bone augmentation delays implant placement and increases risks due to additional surgeries. Implant systems compatible with reduced alveolar bone volume are required. To design, manufacture, and test a non-cylindrical dental implant system using piezotomes and custom-designed matching titanium mini-implants to address the needs of patients with missing teeth and narrow jawbone.

MATERIALS AND METHODS

Tapered mini-implants with a rectangular cross-section (4.6 mm × 2.1 mm) were machined with dimensions that could accommodate narrow alveolar ridges. The performance of the implants were tested in both static and fatigue cycle 30° compression tests. Tapered, rectangular cutting tools that matched the overall trapezoidal morphology of the implant were also designed. These novel tools were engineered to be compatible with commercially available piezoelectric osteotomes. Tools were optimized using finite element analysis and were manufactured accordingly and were used by a periodontal surgery team in a pork rib bone model to monitor utility of the device and ease of use.

RESULTS

The rectangular design of the implant allows for a full occlusal load due to the larger implant flexural rigidity compared to a similar diameter mini-implant with a standard cylindrical design. During 30° compression fatigue tests, the implant tested at 340 N did not fail after 5M cycles as shown in Kaplan-Meier survival curves. Finite element analysis allowed for functional optimization of the roughing and finishing tools. In the pork rib model, these tools successfully cut trapezoidal holes that matched the dimensions of the implant.

CONCLUSIONS

The implant system here demonstrates the feasibility of a mini-implant system that has superior flexural rigidity and potentially circumvents the need for patient bone augmentation.

[Clinical evaluation of the innovative concept of teeth saving]

AIM

To evaluate the effectiveness of the innovative concept of dental medical technologies in patients with resected (amputated) roots of teeth with and without periodontal diseases.

MATERIAL AND METHODS

Of the 516 examined patients with periapical destructive foci of infection of various genesis, 4 clinical groups of 24 people were randomly formed: (1) with a diagnosis of apical periodontitis of incisors, canines or premolars with individual milled transdental implants made of zirconium dioxide; (2) patients with a similar diagnosis and concomitant periodontitis of moderate severity with the same implants; (3) patients with periapical destructive process of molars without periodontitis with the same implants. Control group (4) included patients with similar diagnoses with resection of the root apex without implantation. Patients of the study groups were operated in accordance with the developed clinical protocols, including the manufacture and installation of individual transdental implants with fixation in the postoperative period, developed within the framework of tooth-preserving technologies of immobilizing structures.

RESULTS

The reinforcement of teeth with resected roots with transdental implants together with immobilization of these teeth in the postoperative period restores the biomechanical characteristics of the tooth 2.7 times more effectively. However, there is a slight change in the mobility of the operated teeth in an earlier period (after 3 months), which is associated with the resorption of the bone-replacing agent used to fill the intraoperative defect and with the defective formation of bone tissue. The values of peritelomeric 6 months after the operation differ from the control by 1.4 units only.

Dental caries prevention strategies among children and adolescents with immigrant - or low socioeconomic backgrounds- do they work? A systematic review

BACKGROUND

This systematic review was designed to uncover the most reliable evidence about the effects of caries preventive strategies in children and adolescents of immigrant or low socioeconomic backgrounds.

METHODS

According to pre-determined inclusion and exclusion criteria, relevant articles focusing on underprivileged groups were electronically selected between January1995 and October 2015. The literature search was conducted in five databases; PubMed, Embase, CINAHL, SweMed+ and Cochrane Library. Accepted languages for included articles were English, German and Scandinavian languages. Abstracts and selected articles in full text were read and assessed independently by two review authors. Systematic reviews and meta-analyses were not included. Also articles with topics of water fluoridation and fluoride toothpaste were excluded, this due to all existing evidence of anti-caries effect for disadvantaged groups. The key data about the main characteristics of the study were compiled in tables and a quality grading was performed.

RESULTS

Thirty-seven articles were selected for further evaluation. Supervised toothbrushing for 5-year-old school children was found to be an effective prevention technique for use in underprivileged groups. Also a child/mother approach, targeting nutrition and broad oral health education of mothers showed effectiveness. For older children, a slow-release fluoride device and application of acidulated phosphate fluoride (APF) gel showed to be effective.

CONCLUSION

On the basis of this review, we maintain that in addition to studies of water fluoridation and fluoride toothpaste, there are other preventive intervention studies providing scientific evidence for caries reduction among children and adolescents with immigrant or low socioeconomic backgrounds.

Recent advances in dental implants

Dental implants are a common treatment for the loss of teeth. This paper summarizes current knowledge on implant surfaces, immediate loading versus conventional loading, short implants, sinus lifting, and custom implants using three-dimensional printing. Most of the implant surface modifications showed good osseointegration results. Regarding biomolecular coatings, which have been recently developed and studied, good results were observed in animal experiments. Immediate loading had similar clinical outcomes compared to conventional loading and can be used as a successful treatment because it has the advantage of reducing treatment times and providing early function and aesthetics. Short implants showed similar clinical outcomes compared to standard implants. A variety of sinus augmentation techniques, grafting materials, and alternative techniques, such as tilted implants, zygomatic implants, and short implants, can be used. With the development of new technologies in three-dimension and computer-aided design/computer-aided manufacturing (CAD/CAM) customized implants can be used as an alternative to conventional implant designs. However, there are limitations due to the lack of long-term studies or clinical studies. A long-term clinical trial and a more predictive study are needed.

Rehabilitation of the atrophic mandible with short implants in different positions: A finite elements study

OBJECTIVE

The aim of this study was to analyze whether the use of inclined short implants without lower transcortical involvement (test model - SI), thus preserving the mandibular lower cortical bone, could optimize stress distribution.

MATERIALS AND METHODS

Six identical atrophic mandible models were created featuring 8mm of height at the symphysis. Two study factors were evaluated: implant length and angulation. Implant length was represented either by short implants (7mm) with preservation of the mandibular lower cortical bone or standard implants (9mm) with a bicortical approach and 3 possible implant positioning configurations: 4 distally-inclined implants at 45° (experimental model), all-on-four, 4 vertical implants. All tridimensional (3D) models were analyzed using the Finite Element Method (FEM) and the Ansys Workbench software.

RESULTS

The maximum stress on the bone at the cervical region of the implants in the experimental model was 132MPa and transcortical involvement with implant inclination yielded higher values (171MPa). Regarding von Mises stress on the retaining screw of the prosthesis, 61MPa was recorded for the experimental model while upright implants had the highest values (223MPa). At the acrylic base, 4MPa was recorded for the experimental model whereas models with upright implants showed the highest stress values (11MPa).

CONCLUSION

Rehabilitation of severely resorbed mandibles with 4 short implants placed distally at 45°, without lower transcortical involvement, were biomechanically more favorable, generating lower stress peaks, than the models with short implants on an all-on-four, or on an upright configuration, with or without lower transcortical involvement.

Prosthetic Consideration in Implant-supported Prosthesis: A Review of Literature

Modern dentistry has changed tremendously with implant therapy. For the successful implant therapy, making a proper treatment plan considering both surgical and prosthetic part in mind is the key of success. Often practitioners tend to create a treatment plan overlooking the basic principles of prosthetic part. This present review has discussed various prosthetic consideration of implant-supported prosthesis. A step-by-step detailed prosthetic option with their indications has been discussed to help all dental implant practitioners in making of an optimal treatment plan for each case.

Dental Implant Length and Diameter: A Proposed Classification Scheme

PURPOSE

To propose a length-and-diameter-based classification scheme for dental implants to standardize terminology in the dental literature and communication between interested parties.

MATERIALS AND METHODS

This study was mainly based on searching two major resources: published scientific research papers and 14 of the most popular dental implant manufacturers. Indexed databases were searched from January 2004 up to and including February 2016 using the keywords "dental implant length" and "dental implant diameter." Retrieved titles and abstracts were screened, and related full-text articles were reviewed. Full-text articles that clearly stated the terms and measurements of implants used were included and considered for proposing this classification scheme.

RESULTS

The initial search for implant diameter and length yielded 1007 and 936 articles, respectively. A total of 85 studies (41 about diameter, 44 about length) were selected and reviewed. The remaining studies (966 about diameter, 892 about length) that did not abide by the eligibility criteria were excluded. The terms "long," "short," "standard," "wide," and "narrow" were the most commonly used terms in the literature. A classification scheme for implants by diameter and length was proposed.

CONCLUSIONS

Indexed publications contain a variety of terms used by authors to describe diameter and length of dental implants without conformity and standardization. The classification scheme proposed in this article could serve as a reference for interested parties.

Two-stage closed sinus lift: a new surgical technique for maxillary sinus floor augmentation

Bone tissue atrophy may constitute a relative contraindication for implantation. The methods used in reconstruction of the alveolar ridge within the lateral section of the maxilla have been well known but not perfect. Presentation of the two-stage, closed sinus lift technique as well as efficacy evaluation of reconstruction of the alveolar ridge in the maxilla within its vertical dimension with the use of this technique. The total procedure was performed in 26 out of 28 patients qualified for the study. The height of the alveolar ridge at the site of the planned implantation was no <3 mm, the width of the ridge was no <5 mm. During the treatment stage 1 the sinus lift was performed for the first time. The created hollow was filled with allogeneic granulate. After 3–6 months stage 2 was performed consisting in another sinus lift with simultaneous implantation. The treatment was completed with prosthetic restoration after 6 months of osteointegration. In 24 out of 26 cases stage 1 was completed with the average ridge height of 7.2 mm. In stage 2, simultaneously with the second sinus lift, 26 implants were placed and no cases of sinusitis were found. In the follow-up period none of the implants were lost. The presented method is efficient and combines the benefits of the open technique—allowing treatment in cases of larger reduction of the vertical dimension and the closed technique—as it does not require opening of the maxillary sinus.

Is immediate reconstruction of the mandible with nonvascularized bone graft following resection of benign pathology a viable treatment option?

PURPOSE

The purpose of this study was to address the following clinical question: Is immediate reconstruction of the mandible with a nonvascularized bone graft after resection of benign pathology a viable treatment option? Another purpose was to determine whether any variables affect the success of this treatment approach.

MATERIALS AND METHODS

The authors implemented a retrospective cohort study from a sample of patients diagnosed with a benign tumor of the mandible who were treated with segmental resection and primary reconstruction with an autogenous nonvascularized bone graft. The predictor variables were age, gender, lesion size, and diagnosis, and the outcome variable was graft success determined by re-establishment of mandibular continuity with sufficient bone for implant placement. The χ(2) test was used for statistical analysis of the categorical data and P values less than .05 were considered statistically significant.

RESULTS

Twenty patients with benign mandibular tumors were treated with transoral resection and immediate reconstruction with nonvascularized bone grafts. The mean age was 28.3 years (range, 9 to 63 yr) and 55% (11 of 20) were men. The most common lesion type was ameloblastoma (13 of 20) and all patients underwent reconstruction with autogenous anterior iliac crest bone grafting. Ninety percent of patients (18 of 20) had successful reconstruction. Ten patients underwent successful implant placement and restoration.

CONCLUSIONS

Using careful patient selection, treatment of benign pathology with transoral resection and immediate reconstruction with a nonvascularized bone graft from the anterior iliac crest can be successful. In addition, the total treatment time from implant restoration to return to preoperative function is minimized. Therefore, this method of treatment is a viable treatment option and an alternative to delayed reconstruction or reconstruction with vascularized bone flaps.