Mauro Marincola

A Histomorphometric Study of Nanothickness and Plasma-Sprayed Calcium-Phosphorous-Coated Implant Surfaces in Rabbit Bone

BACKGROUND Novel implant surface treatments with a nanothickness bioactive ceramic deposition onto rough surfaces have been recently introduced. This study aims to evaluate histologically and histomorphometrically (bone-to-implant contact [BIC] and bone area fraction occupancy [BAFO]) the early bone response to plasma-sprayed calcium-phosphate (PSCaP)-coated versus a 300- to 500-nm thickness bioactive ceramic nano-coated plateau root form implants in a rabbit femur model. METHODS A total of 48 plateau root form implants were bilaterally placed in the distal aspect of the femur of 12 white New Zealand rabbits, remaining for 20, 30, and 60 days in vivo (n = 4 animals per time in vivo, n = 2 implants per surface per animal). After sacrifice, the implants in bone were non-decalcified processed to slides of approximately 30 mum thickness, and were morphologically and morphometrically (BIC and BAFO) evaluated. RESULTS Higher degrees of bone structural organization were temporally observed for the PSCaP surface compared to the nano surface over time. BIC and BAFO was significantly higher (P <0.05) for PSCaP at all implantation times evaluated. CONCLUSIONS Within the limits of this study it is possible to state that bioactive ceramic coatings of both thicknesses were biocompatible and osteoconductive. However, the early bone response was favored by the presence of the thicker PSCaP coating.

A Screwless and Cementless Technique for the Restoration of Single-tooth Implants: A Retrospective Cohort Study

PURPOSE The Integrated Abutment Crown (IAC) is a technique for the fabrication of single-tooth implant-supported crowns where the abutment and the crown are one unit. The abutment-crown complex is connected to the implant with a locking taper. This technique does not use cement to retain the crown or screws to retain the abutment. The purpose of this study was to evaluate the clinical outcome of screwless, cementless single implant-supported crowns (IACs) placed in a general dental practice. MATERIALS AND METHODS A retrospective cohort study was conducted between July 2001 and August 2003. Patients were recalled between January and March 2004. The restorations were evaluated following the modified United States Public Health Service (USPHS) criteria. Several other variables, such as anatomic form, occlusion, soft tissue health, and reconstructive procedures, were also recorded. Descriptive statistics, univariate and multivariate marginal Cox Proportional Hazards Regression models, adjusted for multiple implants in the same patient, were used. RESULTS During the chart review, 108 patients were identified. A cohort of 59 patients with a total of 151 IACs met the inclusion criteria. The Kaplan-Meier survival rate for IACs was 98.7%. Two IACs were removed, one due to implant failure; the other became loose several times and was replaced with a splinted restoration. Excellent marginal adaptation was observed with no clinically discernible interface between the veneer material and the abutment. Nine maxillary anterior IACs loosened on five patients; eight of them were reinserted and continued in function without further problems for the remainder of the study. An IAC located between a tooth and an implant was 2.65 times more likely to have postinsertion complications (p= 0.05). An IAC with incorrect anatomic form (overcontoured) was 3.26 times more likely to have postinsertion complications (p= 0.01). Maxillary anterior IACs adjacent to one tooth and one implant were 3.9 times more likely to come loose (p= 0.05). CONCLUSIONS The clinical outcome of this screwless and cementless system for single implant restorations compares favorably with the experience of screw- and cement-retained single implant restorations within the observation period.

Cumulative Success Rate of Short and Ultrashort Implants Supporting Single Crowns in the Posterior Maxilla: A 3-Year Retrospective Study

Aim To determine cumulative success rate (CSR) of short and ultrashort implants in the posterior maxilla restored with single crowns. Patients and Methods We performed a retrospective study in 65 patients with 139 implants. 46 were ultrashort and 93 short. Implants were placed with a staged approach and restored with single crowns. Success rate, clinical and radiographic outcomes, and crown-to-implant ratio (CIR) were assessed after three years. Statistical analysis was performed by descriptive and inferential statistics. A log-binomial regression model where the main outcome was implant success was achieved. Coefficients and 95% confidence intervals were reported. Analyses were performed with Stata 13.2 for Windows. Results 61.54% of patients were female and mean overall age was 51.9 ± 11.08 years old. Overall CSR was 97.1% (95% CI: 92.4–98.9): 97.9 and 95.1% for short and ultrashort, respectively (P value: 0.33). Four implants failed. Covariates were not associated with CSR (P value > 0.05). Regression model showed coefficients correlated with implant success for ultrashort implants (0.87) and most of covariates but none were statistically significant (P values > 0.05). Conclusions Our results suggest that short and ultrashort implants may be successfully placed and restored with single crowns in the resorbed maxillary molar region.

Focal Osteoporotic Bone Marrow Defects on Dental Implant Treated Patients: A 5-Year Period Prevalence Study

Los implantes dentales se consideran el tratamiento mas eficaz para la ausencia dentaria. Sin embargo, hay algunas condiciones oseas que pueden afectar el proceso de osteointegracion, lo que afecta a las tasas de exito clinico y radiografico. Una de estas condiciones podrian ser los defectos focales osteoporoticos de la medula osea (DFOMO). El objetivo de este estudio fue describir la prevalencia en un periodo de 5 anos de los DFOMO en pacientes tratados con implantes dentales. Se realizo un estudio descriptivo y retrospectivo, con una revision sistematica de los datos clinicos y radiologicos de pacientes tratados en una unidad de implantes dentales desde enero de 2010 hasta diciembre de 2014. Cuando se encontro algun caso de DFOMO, se aplico un cuestionario detallado sobre la ficha en busca de caracteristicas demograficas, medicas y dentales (clinicas y radiograficas). Tambien se realizo un analisis histologico de la submuestra. Se estimo la prevalencia del periodo (PP), el calculo de proporciones e intervalos de confianza con un 95 %. El analisis estadistico se realizo con el programa Stata v. 13.2 para Windows (Stata Corp, TX., EE.UU.). La prevalencia del periodo para los 5 anos de DFOMO fue 9,52 % (IC del 95 %: 6,87 % a 13,5 %). Encontrado 42 defectos en 34 pacientes. Dentro de los pacientes con DFOMO, la edad promedio fue de 55,4±11,9 anos, y 67,64 % fueron mujeres. El 97 % de los defectos se encuentraran en la mandibula. El 79,41 % fue unilateral y 69,04 % con lesiones individuales de perdidas dentarias; el 71,42 % afecto la zona de los molares y 59,52 % se encontro en el lado derecho del maxilar. El analisis histologico revelo celulas inflamatorias, calcificaciones distroficas, material hemorragico y celulas grasas, en todos los casos. La prevalencia de DFOMO fue baja, por lo que debe considerarse como una enfermedad poco frecuente pero que muestra una tendencia creciente y exponencial en el tiempo. Sin datos epidemiologicos previos, estos resultados deben ser considerados para tener precaucion durante los examenes imagenologicos y la planificacion del tratamiento, con el fin de evitar complicaciones quirurgicas o protesicas. Los factores locales como tratamientos endodonticos previos deben ser considerados para dilucidar las razones de su aparicion.

The Immediate Aesthetic and Functional Restoration of Maxillary Incisors Compromised by Periodontitis Using Short Implants with Single Crown Restorations: A Minimally Invasive Approach and Five-Year Follow-Up

The functional and aesthetic restoration of teeth compromised due to aggressive periodontitis presents numerous challenges for the clinician. Horizontal bone loss and soft tissue destruction resulting from periodontitis can impede implant placement and the regeneration of an aesthetically pleasing gingival smile line, often requiring bone augmentation and mucogingival surgery, respectively. Conservative approaches to the treatment of aggressive periodontitis (i.e., treatments that use minimally invasive tools and techniques) have been purported to yield positive outcomes. Here, we report on the treatment and five-year follow-up of patient suffering from aggressive periodontitis using a minimally invasive surgical technique and implant system. By using the methods described herein, we were able to achieve the immediate aesthetic and functional restoration of the maxillary incisors in a case that would otherwise require bone augmentation and extensive mucogingival surgery. This technique represents a conservative and efficacious alternative to the aesthetic and functional replacement of teeth compromised due to aggressive periodontitis.

Building on the proceedings of the McGill conference: implant-retained overdentures in an area of South America.

Purpose:Since the McGill consensus conference, numerous reports have proposed the advantages of the 2–implant-retained overdenture over the conventional denture in the restorative management of the edentulous mandible. The purpose of this article was to demonstrate the use of the 2-implant-retained overdenture in the restorative management of patients with edentulous mandibles in an impoverished population. Materials:To address the studys purpose, the investigators initiated a retrospective cohort study and enrolled a sample of subjects who had mandibular 2-implant overdenture treatment using the protocol described within. The primary predictor variable was whether the patient had mandibular 2-implant overdenture treatment. The primary outcome variable was survival of mandibular 2-implantoverdenture treatment as defined within. Results:The study sample included 35 patients each of whom had 2 mandibular implants placed for a total of 70 implants inserted with the purpose of retaining a mandibular overdenture. The mean clinical follow-up time was 74.7 months, during which there were no incidences of implant failure. Therefore, analytical and survival analyses could not be performed. Conclusion:Given the increase in quality of life and ease in implementation, clinicians should now be suggesting the mandibular 2-implant overdenture as the treatment of choice in the management of the edentulous mandible.

Grafting and Dental Implantation in Patients With Jawbone Cavitation: Case Series and 3-Year Follow-Up.

Purpose: Jawbone cavitation (BC) is not uncommon and is considered to be related to some cases of unexpected implant displacement into deep jawbone space. Here, a series of cases with BC is described, in which the lesions were accidentally found and successfully treated by bone grafting and dental implantation. Methods: Thirty-four partially edentulous patients who were found to have BC during dental implant surgeries were included in this study. Alloplast bone substitute (&bgr;–tricalcium phosphate) grafting with immediate or staged locking-taper implant placement was performed. Bone filling and implants on BC were followed up to 36 months, and they were evaluated clinically and radiographically to verify treatment outcome. Results: A total of 41 BCs were found at premolar and molar regions, which involved one or more teeth breadth. Nearly most of the lesions occurred in the mandible (95.1%, 39/41). Histologically, they were compatible with focal osteoporotic marrow defects. Fifty-two locking-taper implants and final restorations were delivered on 38 BCs. One implant failed due to loss of integration. The overall cumulative 3-year implant survival rate was 98.1%. Conclusion: By carefully examining and managing the surgical bed, the current treatment modality was shown to yield a satisfactory outcome for restoration of edentulous ridge with underneath BC.

Esthetic Outcomes of Immediately Loaded Locking Taper Implants in the Anterior Maxilla: A Case Series Study.

The purpose of this study was to evaluate the esthetic outcome of single-tooth locking taper connection implants placed in the anterior maxilla following a postextractive nonfunctional loading protocol. This preliminary clinical study involving 16 patients evaluated the results of 21 implants placed in areas with high esthetic value. For each implant the pink esthetic score, white esthetic score, cumulative survival rate, and health status of peri-implant tissues were evaluated. The cumulative survival rate was 100% 2 years after prosthetic loading, and the mean total pink esthetic score/white esthetic score was 16.9 ± 1.14 on a maximum value of 20. There was excellent plaque control in all patients, and inflammation indices were within the norm. Within the limits of this study, this immediate nonfunctional loading protocol seems to be a successful procedure esthetically and for the maintenance of peri-implant soft tissues.

Aesthetic Surgical Approach for Bone Dehiscence Treatment by Means of Single Implant and Interdental Tissue Regeneration: A Case Report with Five Years of Follow-Up

The replacement of single anterior teeth by means of endosseous implants implies the achievement of success in restoring both aesthetic and function. However, the presence of wide endoperiodontal lesions can lead to horizontal hard and soft tissues defects after tooth extraction, making it impossible to correctly place an implant in the compromised alveolar socket. Vertical augmentation procedures have been proposed to solve these clinical situations, but the amount of new regenerated bone is still not predictable. Furthermore, bone augmentation can be complicated by the presence of adjacent teeth, especially if they bring with them periodontal defects. Therefore, it is used to restore periodontal health of adjacent teeth before making any augmentation procedures and to wait a certain healing period before placing an implant in vertically augmented sites, otherwise risking to obtain a nonsatisfactory aesthetic result. All of these procedures, however, lead to an expansion of treatment time which should affect patient compliance. For this reason, this case report suggests a surgical technique to perform vertical bone augmentation at a single gap left by a central upper incisor while placing an implant and simultaneously to regenerate the periodontal attachment of an adjacent lateral incisor, without compromising the aesthetic result.

Decontamination Using a Desiccant with Air Powder Abrasion Followed by Biphasic Calcium Sulfate Grafting: A New Treatment for Peri-Implantitis

Peri-implantitis is characterized by inflammation and crestal bone loss in the tissues surrounding implants. Contamination by deleterious bacteria in the peri-implant microenvironment is believed to be a major factor in the etiology of peri-implantitis. Prior to any therapeutic regenerative treatment, adequate decontamination of the peri-implant microenvironment must occur. Herein we present a novel approach to the treatment of peri-implantitis that incorporates the use of a topical desiccant (HYBENX), along with air powder abrasives as a means of decontamination, followed by the application of biphasic calcium sulfate combined with inorganic bovine bone material to augment the intrabony defect. We highlight the case of a 62-year-old man presenting peri-implantitis at two neighboring implants in positions 12 and 13, who underwent access flap surgery, followed by our procedure. After an uneventful 2-year healing period, both implants showed an absence of bleeding on probing, near complete regeneration of the missing bone, probing pocket depth reduction, and clinical attachment gain. While we observed a slight mucosal recession, there was no reduction in keratinized tissue. Based on the results described within, we conclude that the use of HYBENX and air powder abrasives, followed by bone defect grafting, represents a viable option in the treatment of peri-implantitis.