Osseous Remodeling Around Dental Implants

Marginal Bone Loss Around the Implant: A Retrospective Analysis of Bone Remodeling Over Five Years of Follow-Up

INTRODUCTION

Bone remodeling around implants in implant-supported rehabilitation is a continuous debate with no consensus in the literature. This study aimed to investigate the implant- and patient-specific factors contributing to marginal bone loss near the implant.

MATERIALS AND METHODS

We included patients who had implant-supported prosthetic rehabilitation using one implant system, between 2014 and 2018, who had full follow-up documentation and orthopantomography over five years, and who had no unwell-controlled systemic pathologies that may influence bone metabolism.

RESULTS

Eighty-one patients who received 500 implants met the inclusion criteria. We observed approximately 1 mm of bone resorption at the five-year follow-up, with the first 0.78 mm of them being documented at the three-year follow-up. Adults younger than 60 years old had an increase in bone resorption by approximately 30%. No difference was seen between men and women. However, a slight increase in bone resorption at five years was seen in female patients older than 50 years old than in ones younger than 50 years (by 30%). The narrowest diameter (3.5 mm; p = 0.001) and anterior mandible (p = 0.008) had the highest bone resorptions. Contrarily, with an insertion depth of approximately 1 mm (p = 0.004), the splinted implant prosthesis (p = 0.21) and zirconia material of the prosthesis (p = 0.57) had the lowest bone remodeling. Moreover, patients younger than 60 years and female patients above 50 years had an increased bone resorption.

CONCLUSIONS

Bone remodeling is a multifactorial process. The treatment planning has to take into consideration both implant- and patient-specific factors.

Assessment of the Peri-implant Bone Density Following Bicortical Anchored Corticobasal Implants Placement in the Maxillary Arch: A Cross-sectional Prospective Study

AIM

The aim of this cross-sectional prospective study was to evaluate the bone density changes around the bicortical corticobasal implant placed in the maxilla over 18 months of follow-up using cone-beam computed tomography (CBCT), focusing on the comparison between the anterior and posterior teeth and regions.

MATERIALS AND METHODS

Thirty-five subjects (20, 53.26%, were males, and 15, 46.73%, were females) received 380 implants (Basal Cortical Screwable implant, BCS®) at Narsinhbhai Patel Dental College and Hospital, India. Implant survival and success were assessed using Albrektsson criteria for implant success. The peri-implant bone density values were measured using CBCT (Vatech PaX-i 3d Smart) and InVivo software (Anatomage, San Jose, California, USA) at the baseline (immediate postoperative) and at the 18-month follow-up visit. For standardization purposes, the bone density values for only the maxillary implants were measured at the level of the second implant thread in four sites: buccal, mesial, distal, and palatal, respectively. The recorded data were tabulated and grouped according to the tooth's region (anterior/posterior) and sites (mesial, distal, buccal, and palatal).

RESULTS

The implant's survival rate was 100%. After 18 months, the bone density increased significantly (p < 0.05) in all the sites in both anterior and posterior regions. The study's findings revealed a higher bone density increase in the posterior region compared to the anterior region after 18 months of follow-up, except for the palatal site.

CONCLUSION

Within the limitations of this study, an increase in the peri-implant bone density has been associated with the use of corticobasal implants over time, with reported anterior/posterior regional variations.

CLINICAL SIGNIFICANCE

This study provides valuable insights into the bone density changes associated with bicortical corticobasal implants and emphasizes the importance of CBCT in evaluating bone density, as well as the significance of regional considerations in implant dentistry. By integrating these findings into clinical practice, clinicians can improve treatment outcomes and ensure long-term implant survival. How to cite this article: Doshi A, Patel J, Gaur V, et al. Assessment of the Peri-implant Bone Density Following Bicortical Anchored Corticobasal Implants Placement in the Maxillary Arch: A Cross-sectional Prospective Study. J Contemp Dent Pract 2024;25(9):820-829.

Double vertical interrupted suture for optimal adaptation and stabilization of free gingival graft around dental implants: a case report

BACKGROUND

Free gingival graft is commonly used to augment the keratinized mucosa and vestibular depth around dental implants. The proper suturing technique is fundamental to achieve a successful result following free gingival graft. However, there are limited studies that focus on the details of the suturing methods to optimize graft adaptation. The purpose of this technical note is to describe a new suturing technique for optimal approximation and stabilization of free gingival graft around dental implants.

CASE PRESENTATION

Here, we present a 53-year-old Persian female with peri-implantitis and lack of keratinized mucosa around mandibular implants who was a candidate for free gingival graft. A new suturing technique, double vertical interrupted suture, was conducted in the interimplant areas. In addition, the suspensory cross-mattress sutures were added to ensure the adaptation of the graft over the implants. The proposed suturing technique is useful for soft tissue augmentation around multiple implants with concave or uneven recipient bed.

CONCLUSION

The present article describes a novel suturing technique for good adaptation and fixation of free gingival graft around dental implants.

Are Mini Dental Implants Suitable for Support of Crowns or Small Bridges in the Mandibular Incisor Region? A 5-year Longitudinal Study

PURPOSE

It has not been previously studied whether 1-piece category 1 narrow dental implants (≤2.5 mm wide) can successfully support crowns or small bridges. The purpose of this study was to evaluate the long-term benefits of the fixed-type mini dental implants (MDIs) for replacement of mandibular incisors.

MATERIALS AND METHODS

In a prospective cohort study, fixed-type 1-piece MDIs, replacing single or multiple mandibular incisors, supporting metal-ceramic single crowns (unsplinted group), or splinted crowns/small bridges (splinted group) were observed over the period of 5 years. The primary predictor was the splinting status. The primary outcome variables were peri-implant marginal bone level (MBL) change, success, and survival rates (assessed as per Pisa Consensus Conference). The secondary outcomes were dental patient-reported outcome measures (dPROMs) and oral hygiene assessment. Descriptive statistics, Chi-squared test, t-test, Mann-Whitney and Wilcoxon tests, Kaplan-Meier survival analysis, log-rank (Mantel-Cox) comparison, Cox proportional hazard analyses adjusting for number of implants, Spearman correlation, and repeated measures were used for data analysis.

RESULTS

From 44 participants (mean age 56.02 ± 5.72 years), 40 completed the 5-year study: 23 in the splinted and 17 in unsplinted group. Three subjects did not respond, while 1 MDI failed (third year) in the unsplinted group. Mean MBL change in both groups was small; however, it increased over time (-0.22 ± 0.38 mm after 1 year; -0.54 ± 0.56 mm after 5 years; P < .05). After 5 years mean MBL change was -0.59 ± 0.71 mm in the unsplinted and -0.50 ± 0.41 mm in the splinted group (P > .05). Survival analysis revealed no significant difference between the unsplinted (85.7% success, 4.8% failures, and 9.5% satisfactory survivals) and splinted group (93.4% success and 6.6% satisfactory survivals) (P > .05). The group affiliation (unsplinted vs splinted) and number of implants were not significant predictors of MDI failure or survival rates (P > .05). Significant improvement in dPROMs after rehabilitation remained unchanged over 5 years (P > .05). Modified plaque index significantly increased over time, correlating with the MBL loss.

CONCLUSION

MDIs supporting crowns and/or small bridges in the mandibular incisor region showed small rates of marginal bone loss, acceptable success, and survival rates and improved dPROMs over a 5-year observation period.

Biomechanical evaluations of the long-term stability of dental implant using finite element modeling method: a systematic review

PURPOSE

The aim of this study is to summarize various biomechanical aspects in evaluating the long-term stability of dental implants based on finite element method (FEM).

MATERIALS AND METHODS

A comprehensive search was performed among published studies over the last 20 years in three databases; PubMed, Scopus, and Google Scholar. The studies are arranged in a comparative table based on their publication date. Also, the variety of modeling is shown in the form of graphs and tables. Various aspects of the studies conducted were discussed here.

RESULTS

By reviewing the titles and abstracts, 9 main categories were extracted and discussed as follows: implant materials, the focus of the study on bone or implant as well as the interface area, type of loading, element shape, parts of the model, boundary conditions, failure criteria, statistical analysis, and experimental tests performed to validate the results. It was found that most of the studied articles contain a model of the jaw bone (cortical and cancellous bone). The material properties were generally derived from the literature. Approximately 43% of the studies attempted to examine the implant and surrounding bone simultaneously. Almost 42% of the studies performed experimental tests to validate the modeling.

CONCLUSION

Based on the results of the studies reviewed, there is no "optimal" design guideline, but more reliable design of implant is possible. This review study can be a starting point for more detailed investigations of dental implant longevity.

Early soft tissue changes following implant placement with or without soft tissue augmentation using a xenogeneic cross-link collagen scaffold: A volumetric comparative study

OBJECTIVE

Soft tissue augmentation (STA) at implant sites has the potential of improving peri-implant health, esthetics, and marginal bone level stability. The present study aimed at evaluating the volumetric changes occurring following implant placement in sites that received STA compared to non-augmented sites.

METHODS

A total of 26 subjects received a dental implant in a posterior edentulous site. Simultaneous STA with a xenogeneic cross-linked collagen scaffold was performed for the first 13 patients, while the remaining subjects served as the negative control. An intraoral optical scanner was used at baseline and at 12 weeks to generate digital models.

RESULTS

The mean volume (Vol) gain of the test group was 38.43 mm³ , while a mean Vol of -16.82 mm³ was observed for the control group (p < 0.05). The mean thickness of the reconstructed volume (ΔD) was 0.61 and -0.24 mm, for the test and control group, respectively (p < 0.05). Higher linear dimensional changes were observed for the test group (p < 0.05), while no significant differences were observed in terms of keratinized mucosa width and pocket depth changes between the two groups.

CONCLUSIONS

Simultaneous STA with xenogeneic collagen scaffold obtained statistically significant higher volumetric outcomes compared to the non-augmented group.

CLINICAL SIGNIFICANCE

STA at the time of implant placement using a xenogeneic cross-linked collagen scaffold can prevent remodeling of the ridge during the first 12 weeks, as compared to non-grafted implant sites.

Micro-angiogenic patterns around orthodontic implants migrating in bone: A micro-CT study in the rat tail model

AIM

Recent studies revealed that implants can migrate in bone when subjected to continuous loading. Since this process is suspected to be accompanied by bone remodelling, which requires blood vessel formation, the present work aimed at assessing the micro-angiogenic patterns around migrating implants.

MATERIALS AND METHODS

In 16 rats, two customized implants were placed in a single tail vertebra and connected with contraction springs (forces: 0 N, 0.5 N, 1.0 N, 1.5 N). After 2 or 8 weeks of loading, the animals were scanned by micro-CT before and after vasculature perfusion with a silicone rubber. Vessels were segmented by subtraction of the two micro-CT scans. Vessel thickness (V.Th), vessel volume per total volume (VV/TV), and vascular spacing (V.Sp) were assessed in a peri-implant volume of interest (VOI) around each implant.

RESULTS

At 2 weeks of loading, force magnitude was significantly associated with VV/TV and V.Th values (χ²  = 10.942, p < .001 and χ²  = 6.028, p = .010, respectively). No significant differences were observed after 8 weeks of loading.

CONCLUSIONS

Within the limitations of an animal study, peri-implant vessel thickness and density were associated with force magnitude in the early loading phase, whereas effects diminished after 8 weeks of loading.

Rationale for Mini Dental Implant Treatment

Mini dental implants can be used to support crowns and partial and complete dentures in compromised edentulous sites. Lack of bone width or site length may be treated with mini implants. Mini implants have less percutaneous exposure and displacement that may reduce complications. Nonetheless, mini implants transmit about twice the load to the supporting bone, and thus, control of occlusal loading is important. In fixed prosthetics, rounded flat cusps, splinting, implant protective occlusal schemes, and placement only in dense bone sites are features of successful mini implant treatment. With removable prosthetics, multiple mini implants may be needed for appropriate retention and load resistance. Maxillary lateral incisor and mandibular incisor sites may be best suited for mini implant treatment. However, past research on dental implants has been directed at standard sized implants. While mini implants are indeed dental implants, they behave somewhat differently under functional load, and the clinician should be circumspect and very judicious in their use. This article is a mini review and not a systematic review. The topics covered are not pervasive because each would require a monograph or textbook for a complete discussion.