Postextraction implant in sites with endodontic infection as an alternative to endodontic retreatment: a review of literature

A clinical protocol for immediate dental implant placement in post-extraction-infected sites decontaminated with Er,Cr:YSGG laser

BACKGROUND

Placement of dental implants into fresh extraction sockets offers some advantages, such as reduced treatment times and enhanced patient comfort. The Er,Cr:YSGG (Erbium, Chromium-doped: Yttrium, Scandium, Gallium, and Garnet) laser can significantly reduce bacterial concentration after the extraction of a compromised tooth. The aim of this article is to provide a clinical protocol for the management of implants placed in infected extraction sites decontaminated with Er,Cr:YSGG laser.

METHODS

A compromised tooth, which was an abutment for a fixed bridge, with clinical and radiological signs of infection was extracted. The infected site was treated and decontaminated with an Er,Cr:YSGG laser device (Biolase iPlus®) and two implants (Straumann®) were placed in the same surgery, in order to rehabilitate the edentulous area. The intervention was completed by tissue regeneration with biomaterials.

RESULTS

Prosthetic rehabilitation after the surgical phase allowed us to provide correct function and satisfactory esthetics. In the follow-up visit, clinicians found good tissue healing and did not observe any complications, such as implant loss or peri-implantitis. The technique used in our study is repeatable and predictable, but patient selection is very important for this type of protocol as the presence of contraindications can lead to failure. The photoacoustic effect exerted by this type of laser has been proven to be effective against many pathogens. Several authors have previously demonstrated the effectiveness of this technique.

CONCLUSIONS

Immediate implantation in infected sites decontaminated with Er,Cr:YSGG laser does not seem to contribute to an increased risk of failure; however, it is necessary to follow a certain set of protocols and procedures to prevent peri-implantitis and other complications.

Retrospective analysis of dental implants immediately placed in extraction sockets with periapical pathology: immediate implant placement in infected areas

BACKGROUND

The aim of this study is to examine the survival rates of immediate implants placed in extraction sockets with chronic periapical pathology.

METHODS

69 patients and 124 immediate implants were included in the study. The patients included in the study were examined in 3 groups. Group 1: Patients who underwent tooth extraction with periapical pathology and immediate implant placement. Group 2: patients who underwent tooth extraction with periapical pathology, immediate implant placement and guided bone regeneration. Group 3: Patients who underwent tooth extraction with periapical pathology, sinus lift procedure and immediate implant placement. In statistical analysis, t-test and Anova analysis were used in the evaluation of quantitative data, cross-tables and chi-square (χ2) test were used in the evaluation of classified qualitative data. Statistical significance was determined as p < 0.05.

RESULTS

It was observed that 116 (95.55%) of 124 implants were successful and 8 (4.45%) failed. The success rate was 97.2% in Group 1, 93.5% in Group 2 and 81.8% in Group 3. A significant correlation was found between the study groups and implant success in terms of χ2 test (p = 0.037). A significant relationship was found between smoking and success in terms of the χ2 test (p = 0.015).

CONCLUSIONS

High survival rates are observed for immediate implant placement in sockets with periapical pathology. The success rates observed in guided bone regenerations simultaneously with immediate implant placement are at satisfactory levels. In cases where simultaneous sinus lifting procedures are required, the success rates were observed to be significantly lower. In case of adequate curettage and debridement in sockets with periapical pathology, high implant survival rates are observed. As the complexity of the surgical procedure increases, treatment protocols may progress in safer ways.

Immediate implant positioning using tooth-derived bone substitute material for alveolar ridge preservation: Preliminary results at 6 months

OBJECTIVES

In the present study we evaluated the effectiveness of the use of a novel autologous bone substitute derived directly from processing the extracted tooth in the upper premolar area to preserve a suitable esthetic score and functionality.

MATERIAL AND METHODS

Fourteen bone-level implants with platform switching were inserted in 12 patients immediately after atraumatic extraction of premolars for restorative or endodontic reasons. The implant buccal bone gap was filled using autologous tooth extracted-derived material. Clinical and radiographic parameters, including Pink Esthetic Score (PES) were evaluated at 6 months.

RESULTS

A total of 10 patients accounting for 11 implants were included. PES showed a suitable esthetic result, and all the implant-prosthetic rehabilitation reported full satisfaction for masticatory function, phonetics, and aesthetics. Bone levels were stable and not affected by implant location, lesion type, or bone quality.

CONCLUSION

Radiographically the autologous bone substitute used appears stable in the surgical site and there is good continuity between the autologous bone and the graft. No adverse effects such as periodontal inflammation, infection, or graft rejection was reported.

Immediate dental implant placement in post-extraction-infected sites decontaminated with Er,Cr:YSGG laser: a retrospective cohort study

Dental implants placed in fresh extraction alveoli provide several advantages, including shorter treatment periods and improved patient comfort. After a compromised tooth extraction, the Er,Cr:YSGG laser can considerably reduce bacterial concentration. The objective of this controlled study conducted after at least 1 year of follow-up was to compare the use of immediate post-extraction implants in infected sites treated with laser (test group) versus conventional implants in edentulous sites (control group) through an analysis of pre- and post-operative radiographs. The study was based on a series of patients treated between 2014 and 2019, with a 1-year minimum follow-up, and up to over 4 years. An analysis of the clinical history of the treated patients and pre- and post-operative radiographs was performed to evaluate the implant success and to measure the marginal bone level (MBL). Overall, 149 implants were studied. There was only one failure in the test group (1%) and no failures in the control group. The test group gained 0.1 mm of the MBL compared to the baseline, while the control group lost 0.1 mm of the MBL. The difference between the two groups of only 0.2 mm was not statistically significant (P = 0.058). Immediate dental implants in infected sockets debrided and decontaminated using Er,Cr:YSGG laser do not appear to enhance the likelihood of failure; however, peri-implantitis and associated problems must be avoided by following a certain set of protocols and procedures.

The efficacy of different instruments combined with Nd:YAP in endodontic retreatment

Background

To evaluate the efficiency of endodontic retreatment using different instruments and observe whether the Nd:YAP laser can assist.

Methods

Eighty premolars were selected, of which the root canals were prepared, and were filled with both gutta-percha and AH plus. The teeth were randomly divided into eight groups, respectively using and not using the Nd:YAP laser with the use of H files, Reciproc files, Mtwo R files, and Mtwo R + H files to remove the root-canal filling material. The retreatment time of each sample was recorded, and the amount of residual gutta-percha was calculated by Image J.

Results

(I) In the four no-Nd:YAP laser groups, the Mtwo R group and Reciproc group took the least time, and there was no statistical difference between them (P>0.05). The Mtwo R + H file group took longer than the Mtwo R group and Reciproc group (P<0.05). The H file group took the longest time (P<0.05). (II) In the Nd:YAP laser group, the H file group took the longest time (P<0.05), and there were no significant statistical difference between the other three groups (P>0.05). (III) The Nd:YAP laser groups took a longer time than the no-Nd:YAP laser groups (P<0.05). (IV) All of the groups had residues. (V) The residues in the Mtwo R + H files group and the Reciproc group were the least among the four groups (P<0.05), and the residues in the Mtwo R group were the most (P<0.05). (VI) The residues in the Mtwo R and H file groups of the Nd:YAP laser groups were less than those of the no-Nd:YAP laser groups (P<0.05), and the residues in the Reciproc and the Mtwo R + H file groups of the Nd:YAP laser group showed no statistical difference with that of the no-Nd:YAP laser group (P>0.05).

Conclusions

None of the experimental methods could altogether remove the root-filling material. The Nd:YAP laser could assist, but the procedure still took a long time and the efficiency of endodontic retreatment was limited. Using the Mtwo R + H or Reciproc file was the most efficient.

Management of Postsurgical Complication in Multiple Implant-Infected Postextraction Sites in the Lower Arch

Currently, dental implants are a very frequent therapeutic alternative for replacing missing teeth. However, they are not exempt from developing complications of infectious origin. Therefore, this case report describes a 67-year-old female patient presenting infectious complications caused by suture rupture. Surgery combined with therapeutic management with antibiotics was performed, allowing preservation of the osseointegration of the implants in the lower arch. Within the limitations of this study, it was shown that more research is needed to determine the success and survival of implants presenting complications due to infections during the osseointegration process.

Immediate Implant Placement in Infected Sockets: A Consecutive Cohort Study

Introduction: Immediate placement of implants in a fresh post-extraction socket is an increasingly popular and established treatment option. However, active infection in the extraction site may adversely affect the outcome of this procedure. This study was designed to assess the clinical results of immediate placement of dental implants in infected extraction sockets using a standardized protocol, which included (a) the use of an Er,Cr:YSGG laser for the decontamination of the infected socket prior to implant insertion, and (b) the utilization of an in situ hardening alloplastic bone graft substitute to augment the gap between the implant surface and the labial plate of bone. Patients and Methods: A retrospective record review was used to identify 68 patients who had implants placed as per the described protocol. A total of 126 implants were placed in 68 patients (65 implants in the maxilla, 61 implants in the mandible). The implants were loaded 136 ± 73 days (mean ± standard deviation; range: 37–400 days) after implant placement. Eight patients (16 implants) were subsequently lost to follow up. Results: 105 of the 110 implants (95.45%) placed immediately in the infected sites using the described protocol survived after prosthetic loading. Conclusion: Immediate implant placement in previously infected sites using the protocols mentioned in our study with laser decontamination of the socket, grafting with an in situ hardening alloplastic bone graft material and non-submerged healing shows a similar survival rate to the published success rates for immediate implants placed in non-infected sites.

External Connection versus Internal Connection in Dental Implantology. A Mechanical in vitro Study

(1) Background: In today's dentistry, implantology has become a therapeutic resource of choice in certain clinical situations. The design of implants has evolved in several aspects since their inception. Dental implants were initially designed with an external hex connection, although due to force transmission and security in the adjustment of the prosthesis, later implants featured an internal hex connection. This study aims to analyse the mechanical properties of two types of implants (an internal connection and an external connection) from the same manufacturer and their different prosthetic components (union screw between implant and prosthetic abutment, and the abutment itself) when subjected to different types of load. (2) Materials and methods: Intraosseous dental implants of similar shape, design and size, although different in type of connection (external vs. internal), were studied. The specifications of the UNI EN ISO 14801 test standard were used, with all determinations being carried out three times. Finally, the dimensional characterisation of the samples analysed after the dynamic load study was carried out, and the values of both study groups were compared by means of the non-parametric Mann–Whitney U test to find statistically significant differences (p < 0.05). (3) Results: For the static characterisation test, we found between 610.9 N and 986.1 N for the external connection and between 1263.6 N and 1324 N for the internal connection (p = 0.011). All of the dynamic load tests were positive and there was no failure in any of the components studied. (4) Conclusions: After the analysis of the samples studied in vitro, satisfactory results were obtained, demonstrating that both connections can support considerable mechanical loads according to international standards (UNI EN ISO 14801).

Roles of a new drug-delivery healing abutment in the prevention and treatment of peri-implant infections: a preliminary study

In this study we modified the common healing abutment into a specifically designed drug-delivery abutment (DDA), which is a hollow columnar system with drug-distribution holes in peripheral wall. The objective of this study was to investigate the possibility of the prevention and treatment of peri-implant diseases with this drug-delivery system. Minocycline hydrochloride was added to DDAs with different hole diameters, and then subjected to bacteria-inhibition tests in vitro with three oral bacterial strains, namely, Streptococcus mutans, Streptococcus sanguinis, and Porphyromonas gingivalis. The implants were placed into the mandible of beagle dogs. DDAs with or without minocycline and normal healing abutments were installed. One week after surgery, the plaques on all the abutments were analyzed by plaque stain. Following this, both abutments and adjacent teeth received oral hygiene to maintain a healing environment. Eleven weeks later, the ligature-induced experimental peri-implantitis model was set up for eight weeks. Periapical radiographs and clinical measurements were performed during the process. We found that inhibition zones were observed surrounding all the tested drug-delivery abutments in all three bacterial strains. One week after implant installation, oral plaque formed on the DDAs with minocycline was significantly less than that on normal abutments and DDAs without drugs. DDA with the minocycline group showed a relatively slower rate of deterioration of the mucosal inflammation and probing depth in the experimental peri-implant lesions. We suggest that this drug-delivery abutment could effectively deliver medications into peri-implant tissues to minimize plaque formation and relieve peri-implant inflammation in the experimental peri-implantitis model.

We modified a normal abutment into a drug delivery abutment and discussed its possible application in the prevention and treatment of peri-implant infections.

Immediate post-extraction implants with or without pure platelet-rich plasma: a 5-year follow-up study

PURPOSE

The purpose of this study was comparison of clinical and radiographic outcomes of immediate post-extraction implants with or without the use of pure platelet-rich plasma (P-PRP) in the short- and medium-term follow-up.

METHODS

A retrospective analysis was performed to assess soft tissue healing, implant and prosthesis survival, marginal bone level changes and biological complications.

RESULTS

A total of 109 partially edentulous patients with 126 implants were included in this analysis. At 4-5 years after loading, cumulative survival rate in test group was 97.4% and in control group was 97.8%, with no significant differences. After 5 years of function, marginal bone loss (MBL) in test group was 0.8 ± 0.35 and 1.02 ± 0.27 mm for immediate and delayed loading, respectively, and in control group was 0.6 ± 0.16 and 0.8 ± 0.89 mm for immediate and delayed loading, respectively. No significant differences in MBL were observed intragroups and intergroups at any time point considered. Soft tissue healing score was significantly higher in test group compared to the control at 3 and 7 days after surgery, with significant differences.

CONCLUSIONS

P-PRP implant group showed a better soft tissue management and wound healing in the first 7 days after surgery compared to non-P-PRP implant group. In the medium-term follow-up, comparable clinical and radiographic outcomes were noticed between two groups.

Immediate implants placed in fresh sockets associated to periapical infectious processes. A systematic review

Objetives: The development of treated implant surfaces, added to the increase of the aesthetic requirements by the patients has led to a change in the treatment protocols as well as the development of techniques such as the one-fase implants and the immediate prosthetic loading. One of the usual contraindications of the implant treatment is the presence of periapical disease associated to the tooth to be replaced. The aim of this paper is to review the published literature on immediate implant placement in extraction sockets of teeth with periapical pathology, considering the level of scientific evidence, and following the principles of medicine and evidence-based Dentistry. Material and Methods: A search of articles published between 1982 and 2012 was conducted. The search terms immediate, dental implant, extraction, infected, periapical pathology were used. Search was limited to studies in animals and humans, published in english language. Results: 16 articles were selected from a total of 438, which were stratified according to their level of scientific evidence using the SORT criteria (Strength of Recommendation Taxonomy). Studies in both animals and humans presented high rates of implant survival, but human studies are limited to a small number of cases. Discussion and Conclusions: There is a limited evidence regarding implant placement immediately to the extraction of teeth affected by chronic periapical pathology. Following analysis of the articles, and in function of their scientific quality, a type B recommendation is given in favor of the immediate implant placement in fresh sockets associated to periapical infectious processes.

Key words:Immediate implant, periapical pathology.