Clinical outcomes in the presence and absence of keratinized mucosa in mandibular guided implant surgeries: a pilot study with a proposal for the modification of the technique

Evaluation of the Effectiveness of the Use of the Diode Laser in the Reduction of the Volume of the Edematous Gingival Tissue after Causal Therapy

Aim: The aim of this study was to evaluate and compare two different techniques for the treatment of plaque-induced gingivitis, demonstrating whether the causal therapy supported by diode laser can allow a resolution of the edema caused by gingivitis in less time compared to the single traditional causal therapy. Materials and methods: Twenty-five patients between 20 and 60 years of age with a specific diagnosis of gingivitis were evaluated at the CLID-HSR oral hygiene department. Once the clinical parameters (bleeding index, plaque index, recession, and clinical attack level) were recorded, each of them was subjected to a professional oral hygiene session and instructed in correct home hygiene procedures. Through a split-mouth protocol for each individual patient, hemi-arches were treated by simple randomization to be treated with causal therapy supported by the action of the diode laser (experimental therapy) and which with traditional causal therapy (control therapy). A first intraoral scan was performed before therapy (T0), which was repeated 20 min after rinsing with CHX. The intraoral scans were repeated at a control 7 (T1) and 14 days (T2) after the session. For each intraoral scan, a volumetric value was calculated, proportional to the edema of the gingival tissues, using special digital software. The operator who carried out the volumetric measurements on the software was not aware of the therapy implemented on each half-arch. The operator who carried out the statistical analysis was not aware of the therapy applied to each group. The collected data were statistically compared in order to detect any differences between the volumetric variations between the two therapy groups and within the therapy groups over time. After evaluating the distribution of data by means of the Kolmogorov-Smirnov statistical test, the appropriate nonparametric tests were chosen to carry out the statistical comparisons. Results: Based on the analysis of the gingival-periodontal health parameters and the volumetric value of the treated areas, no statistically significant differences were detected between the areas treated with the adjuvant action of the diode laser compared to those treated with causal therapy alone. Conclusions: With the limitations of this study, in accordance with the statistical results obtained, diode laser therapy does not allow a faster resolution of gingival edema compared to traditional therapy; the two treatment techniques for plaque-induced gingivitis, therefore, have the same efficacy.

The Workflow of a New Dynamic Navigation System for the Insertion of Dental Implants in the Rehabilitation of Edentulous Jaws: Report of Two Cases

Background: This case series describes the surgical workflow during maxillary full-arch rehabilitations in two patients through the All-on-4 concept (standard and hybrid) assisted by DTX Studio Implant Software planning and X-Guide Navigation. Results: The X-Guide Navigation enabled the drills and implants to be positioned and oriented precisely, allowing the implants to be positioned favorably under the surgical and prosthetic points of view through the avoidance of damage to the maxillary sinus and nasal cavity. Dynamic navigation-assisted surgery provided advantages, including the possibility to modify the implants’ system, length, or location perioperatively. However, it must be underlined that to achieve proficiency with this technology it is necessary to consider a necessary learning curve. Conclusion: The insertion of dental implants assisted by dynamic navigation for maxillary full-arch rehabilitations was considered a safe and predictable procedure. Nevertheless, it can be improved (such as with a simpler fiducial markers protocol), aiming to simplify the procedure.

Double Guided Surgery in All-on-4® Concept: When Ostectomy Is Needed

Background

The rehabilitation of edentulous jaws with guided and flapless surgery applied to the All-on-4 concepts is a predictable treatment with a high implant and prosthetic survival rates, but there are several contraindications for this technique like when bone reduction is needed due to a high smile line in the maxilla or when there is an irregular or thin bone crest.

Purpose

To report a technique with double guided surgery for bone reduction and implant placement with the All-on-4 concept.

Materials and Methods

7 patients were included in the study. Guided implant planning was performed using CBCT, and the virtual templates were created with three dedicated software. Custom surgical templates were made for the ostectomy and for implants positioning.

Results

28 implants were placed using a double bone-supported surgical guide. The mean angular errors between the preoperative-planned implant and the postoperative-placed implant were 2.155° ± 2.03°; the mean distance errors between the planned and the placed implants were 0.763 mm ± 0.55 mm on the shoulder implant and 0.570 mm ± 0.40 mm on the apex implant.

Conclusions

The results of our study indicate that this treatment is predictable with an excellent survival rate allowing excellent results even when bone reduction is mandatory.

Soft tissue augmentation around osseointegrated and uncovered dental implants: a systematic review

OBJECTIVES

The aim was to compile the current knowledge about the efficacy of different soft tissue correction methods around osseointegrated, already uncovered and/or loaded (OU/L) implants with insufficient soft tissue conditions. Procedures to increase peri-implant keratinized mucosa (KM) width and/or soft tissue volume were considered.

MATERIALS AND METHODS

Screening of two databases: MEDLINE (PubMed) and EMBASE (OVID), and manual search of articles were performed. Human studies reporting on soft tissue augmentation/correction methods around OU/L implants up to June 30, 2016, were considered. Quality assessment of selected full-text articles to weight risk of bias was performed using the Cochrane collaboration's tool.

RESULTS

Overall, four randomized controlled trials (risk of bias = high/low) and five prospective studies (risk of bias = high) were included. Depending on the surgical techniques and graft materials, the enlargement of keratinized tissue (KT) ranged between 1.15 ± 0.81 and 2.57 ± 0.50 mm. The apically positioned partial thickness flap (APPTF), in combination with a free gingival graft (FGG), a subepithelial connective tissue graft (SCTG), or a xenogeneic graft material (XCM) were most effective. A coronally advanced flap (CAF) combined with SCTG in three, combined with allogenic graft materials (AMDA) in one, and a split thickness flap (STF) combined with SCTG in another study showed mean soft tissue recession coverage rates from 28 to 96.3 %. STF combined with XCM failed to improve peri-implant soft tissue coverage.

CONCLUSIONS

The three APPTF-techniques combined with FGG, SCTG, or XCM achieved comparable enlargements of peri-implant KT. Further, both STF and CAF, both in combination with SCTG, are equivalent regarding recession coverage rates. STF + XCM and CAF + AMDA did not reach significant coverage.

CLINICAL RELEVANCE

In case of soft tissue deficiency around OU/L dental implants, the selection of both an appropriate surgical technique and a suitable soft tissue graft material is of utmost clinical relevance.

Soft tissue augmentation procedures at second-stage surgery: a systematic review

OBJECTIVES

The aim of this systematic review was to evaluate the efficacy of different soft tissue augmentation/correction methods in terms of increasing the peri-implant width of keratinized mucosa (KM) and/or gain of soft tissue volume during second-stage surgery.

MATERIALS AND METHODS

Screening of two databases, MEDLINE (PubMed) and EMBASE (OVID), and hand search of related articles, were performed. Human studies reporting on soft tissue augmentation/correction methods around submucosally osseointegrated implants during second-stage surgery up to July 31, 2015 were considered. Quality assessment of the selected full-text articles was performed according to the Cochrane collaboration's tool to assess the risk of bias.

RESULTS

Overall, eight prospective studies (risk of bias: high) and two case series (risk of bias: high) were included. Depending on the surgical technique and graft material used, the enlargement of keratinized tissue (KT) ranged between -0.20 and 9.35 mm. An apically positioned partial-thickness flap/vestibuloplasty (APPTF/VP) in combination with a free gingival graft (FGG) or a xenogeneic graft material (XCM) was most effective. Applying a roll envelope flap (REF) or an APPTF in combination with a subepithelial connective tissue graft (SCTG), mean increases in soft tissue volumes of 2.41 and 3.10 mm, respectively, were achieved. Due to the heterogeneity of study designs, no meta-analysis could be performed.

CONCLUSIONS

Within the limitations of this review, regarding the enlargement of peri-implant KT, the APPTF in the maxilla and the APPTF/VP in combination with FGG or XCM in the lower and upper jaw seem to provide acceptable outcomes. To augment peri-implant soft tissue volume REF in the maxilla or APPTF + SCTG in the lower and upper jaw appear to be reliable treatment options.

CLINICAL RELEVANCE

The localization in the jaw and the clinical situation are crucial for the decision which second-stage procedure should be applied.

Definition, etiology, prevention and treatment of peri-implantitis--a review

Peri-implant inflammations represent serious diseases after dental implant treatment, which affect both the surrounding hard and soft tissue. Due to prevalence rates up to 56%, peri-implantitis can lead to the loss of the implant without multilateral prevention and therapy concepts. Specific continuous check-ups with evaluation and elimination of risk factors (e.g. smoking, systemic diseases and periodontitis) are effective precautions. In addition to aspects of osseointegration, type and structure of the implant surface are of importance. For the treatment of peri-implant disease various conservative and surgical approaches are available. Mucositis and moderate forms of peri-implantitis can obviously be treated effectively using conservative methods. These include the utilization of different manual ablations, laser-supported systems as well as photodynamic therapy, which may be extended by local or systemic antibiotics. It is possible to regain osseointegration. In cases with advanced peri-implantitis surgical therapies are more effective than conservative approaches. Depending on the configuration of the defects, resective surgery can be carried out for elimination of peri-implant lesions, whereas regenerative therapies may be applicable for defect filling. The cumulative interceptive supportive therapy (CIST) protocol serves as guidance for the treatment of the peri-implantitis. The aim of this review is to provide an overview about current data and to give advices regarding diagnosis, prevention and treatment of peri-implant disease for practitioners.