Stuart J. Froum

Peri-implant mucositis and peri-implantitis: A current understanding of their diagnoses and clinical implications

Theuseofdental implantshas revolutionized the treatment of partially and fully edentulous patients today. Implants have becomea treatment approach formanaging a broad range of clinical dilemmas due to their high level of predictability and their ability to be used for a wide variety of treatment options. While in many cases dental implants have been reported to achieve long-term success, they are not immune fromcomplications associated with improper treatment planning, surgical and prosthetic execution, material failure, and maintenance. Included in the latter are the biologic complications of peri-implant mucositis and peri-implantitis, inflammatory conditions in the soft and hard tissues at dental implants. It is the purpose of this paper to review the current knowledge concerning peri-implant mucositis and peri-implantitis to aid clinicians in their diagnoses and prevention. It is recognized that new information will continue to emerge, and as such, this document represents a dynamic endeavor that will evolve and require further expansion and reevaluation.

Survival Rate of Immediately vs Delayed Loaded Implants: Analysis of the Current Literature

Immediate loading of oral implants has been reported as a beneficial treatment protocol in implant dentistry that increases the comfort of the patient. However, documentation in the literature is poor regarding the clinical outcome and the peri-implant bone response of immediately loaded implants compared with the conventional loading protocol placed in different bone qualities. The aim of this report was to present the role of bone quality in the survival rate of implants using conventional or immediate loading according to the literature. A literature search analysis was performed to demonstrate the survival rate of immediately loaded implants, as well as data from the histologic and histomorphometric evaluation in comparison with conventional loaded implants. This analysis showed high survival rates of immediately loaded implants along with osseointegration, with high percentages of bone-to-implant contacts based on histologic evaluation from human and animal studies of immediately and conventionally loaded implants. This study may provide histologic and clinical evidence of the immediate loading protocol for different bone qualities.

Extraction Sockets and Implantation of Hydroxyapatites With Membrane Barriers A Histologic Study

The purpose of this pilot study was to investigate the effect on extraction socket healing when an absorbable hydroxyapatite (AH) and a nonabsorbable anorganic bovine bone mineral (ABB) covered with either an acellular dermal matrix allograft (ADMA) or expanded polytetrafluoroethylene (ePTFE) membrane barrier were left exposed to the oral cavity. Following tooth extraction, a total of 16 sockets in 15 patients with deficient buccal plates of ≥5 mm were randomly divided into 4 treatment groups: 1) AH covered with ADMA, 2) AH covered with an ePTFE membrane, 3) ABB covered with ADMA, and 4) ABB covered with an ePTFE membrane. Primary coverage was not attempted or obtained in any of the 16 treated sockets. Six to 8 months postextraction at the time of implant placement, histologic cores of the treatment sites were obtained. These cores were processed, stained with Stevenel’s blue/van Gieson’s picro fuchsin, and histomorphometrically analyzed. Vital bone, connective tissue and marrow, and residual graft particles were reported as a percentage of the total core. The mean vital bone was 34.5% (AH with ADMA), 41.7% (ABB with ADMA), 27.6% (ePTFE and AH), and 17.8% (ePTFE and ABB). The average percentage of vital bone in the 8 sockets covered with ADAMA was 38% compared with an average percentage vital bone of 22% in the 8 sockets covered with ePTFE membrane barriers. Because of the small number of specimens in the 4 groups, statistical analysis was not possible. However, in this pilot study, ADMA-covered sites resulted in more vital bone present 6 to 8 months postsocket treatment than obtained in the ePTFE-covered sites regardless of bone replacement materials used. Further research is warranted to see if these results show a similar difference in bone-to-implant contact after implant placement.

Maxillary sinus elevation by lateral window approach : evolution of technology and technique

CONTEXT The maxillary sinus elevation procedure has become an important pre-prosthetic surgical procedure for the creation of bone volume in the edentulous posterior maxilla for the placement of dental implants. Research and clinical experience over the past 30 years has increased the predictability of this procedure as well as reduced patient morbidity. EVIDENCE ACQUISITION Data on grafting materials and implant survival rates comes from 10 published evidence-based reviews that include all relevant published data from 1980 to 2012. Supporting clinical material comes from the experience of the authors. EVIDENCE SYNTHESIS The evidence-based reviews report and compare the implant survival rates utilizing various grafting materials, implant surfaces, and the use or non-use of barrier membranes over the lateral window. Clinical studies report on complication rates utilizing piezoelectric surgery and compare them to complication rates with rotary instrumentation. CONCLUSIONS The conclusions of all the evidence-based reviews indicate that the utilization of bone replacement grafts, rough-surfaced implants, and barrier membranes result in the most positive outcomes when considering implant survival. Further, the utilization of piezoelectric surgery, rather than rotary diamond burs, for lateral window preparation and membrane separation leads to a dramatic reduction in the occurrence of the intraoperative complications of bleeding and membrane perforation.

The use of CO(2) laser in the treatment of peri-implantitis.

Different techniques have been used for the treatment of peri-implant defects. However, there are always questions about the issue of reosseointegration. The present paper explores the recent literature on the topic of peri-implantitis therapy, and presents a surgical protocol for implant surface decontamination using the CO(2) laser, grafting of the defect, and coverage with a membrane according to a clinical case. The results appear to be promising and may improve the long-term clinical outcomes of failing dental implants.

Clinical Consensus Statement Appropriate Use of Computed Tomography for Paranasal Sinus Disease

Objective To develop a consensus statement on the appropriate use of computed tomography (CT) for paranasal sinus disease. Subjects and Methods A modified Delphi method was used to refine expert opinion and reach consensus by the panel. Results After 3 full Delphi rounds, 33 items reached consensus and 16 statements were dropped because of not reaching consensus or redundancy. The statements that reached consensus were grouped into 4 categories: pediatric sinusitis, medical management, surgical planning, and complication of sinusitis or sinonasal tumor. The panel unanimously agreed with 13 of the 33 statements. In addition, at least 75% of the panel strongly agreed with 14 of 33 statements across all of the categories. Conclusions For children, careful consideration should be taken when performing CT imaging but is needed in the setting of treatment failures and complications, either of the pathological process itself or as a result of iatrogenic (surgical) complications. For adults, imaging is necessary in surgical planning, for treatment of medical and surgical complications, and in all aspects of the complete management of patients with sinonasal and skull base pathology.

Implant Periapical Lesions: Etiology and Treatment Options

Implant failures due to apical pathology are conditions that have not been extensively studied nor reported in the literature. The implant periapical lesion (IPAL) has different symptoms, and several etiologies have been proposed in the literature. This article reviews cases of IPAL reported in peer-reviewed journals and presents possible treatment options. Analysis of the data collected was performed based on diagnosis, cause of extraction of the natural tooth, location, period of implant placement, implant surface, and treatment approach. Even the data presented in this review are based on few reported cases the etiology of these lesions seems to be multifactorial or with an unknown origin. Contamination of the implant surface, bone overheating during surgery, excessive torquing of the implant, poor bone quality, perforation or thinning of the cortical bone, premature or excessive load over the fixture, fracture of the bone inside the hollow portion of the hollow implant, and an implant placement in an infected maxillary sinus have been discussed. In general, areas around endodontically compromised teeth should be carefully analyzed prior to implant placement to prevent implant failures.

A two-stage full-arch ridge expansion technique: review of the literature and clinical guidelines.

Ridge expansion techniques have been acknowledged to offer several advantages in the correction of ridge deformities. The expanded defect heals in a similar manner to an extraction socket. In selected cases patients can wear their dentures after surgery. Secondary surgical sites are not a prerequisite, and simultaneous implant placement can be achieved during ridge expansion. The limitation of this technique lies in its inability to create bone vertically. Therefore, it is not indicated for the correction of vertical defects. The application of the split ridge expansion technique has been reported in the literature as it pertains to partially edentulous deficient ridges. The purpose of this article was to present the application of the split ridge expansion technique in the fully edentulous maxilla and discuss the distinction between the immediate or one-stage approach and the delayed or two-stage approach. Histologic results are discussed. Two case reports demonstrate the results that can be obtained with this technique.

Effect of Maxillary Sinus Membrane Perforation on Vital Bone Formation and Implant Survival: A Retrospective Study

BACKGROUND The maxillary sinus augmentation procedure (SAP) using the lateral window technique has been documented to be a highly predictable procedure. However, the most common intraoperative complication has been reported to be maxillary sinus membrane perforation (MSMP). The present study evaluates the percentage of vital bone and implant survival in sinuses that had perforations repaired during surgery versus a non-perforated sinus group. METHODS Data were obtained retrospectively from an Institutional Review Board-approved anonymous database at New York University, Kriser Dental Center, Department of Periodontology and Implant Dentistry, New York, New York, from 23 patients who had undergone SAP with a total of 40 treated sinuses. Sinuses were grafted with mineralized cancellous bone allograft, anorganic bovine bone matrix, or biphasic calcium phospate. Perforation complications occurred in 15 sinuses with 25 non-perforated sinuses. All perforations were repaired during surgery with absorbable collagen membrane barriers. Histologic cores were taken from all treated sinuses 26 to 32 weeks after surgery. The implant success rate of 79 placed implants was recorded. RESULTS The average percentage of vital bone was 26.3% ± 6.3% in the perforated (repaired) sinuses versus 19.1% ± 6.3% in the non-perforated sinuses. The differences were statistically significant (SS). The implant success rate was 100% (35 of 35) compared to 95.5% (43 of 45) in the perforated/repaired vs. non-perforated sinuses, respectively. There was no SS difference in implant failure rates. CONCLUSIONS The augmented sinuses in this study that exhibited MSMPs that occurred during the SAP (which were treated during surgery) show SS greater vital bone percentages compared with the non-perforated sinus group. There were no SS differences in implant survival in the perforated versus non-perforated groups. In this study, sinus MSMPs, when properly repaired during surgery, do not appear to be an adverse complication in terms of vital bone production or implant survival.

The Use of CO2 Laser in the Treatment of Peri-implantitis

Different techniques have been used for the treatment of peri-implant defects. However, there are always questions about the issue of reosseointegration. The present paper explores the recent literature on the topic of peri-implantitis therapy, and presents a surgical protocol for implant surface decontamination using the CO(2) laser, grafting of the defect, and coverage with a membrane according to a clinical case. The results appear to be promising and may improve the long-term clinical outcomes of failing dental implants.