International Journal of Oral Implantology, 04/2024

Purpose: To compare the medium- and long-term efficacy of implants and removable prostheses used to manage edentulous patients with florid cemento-osseous dysplasia. Materials and methods: The PubMed, Web of Science and Google Scholar databases were searched from December 2022 to March 2023. Two independent reviewers completed the search using a population, intervention, comparison, outcome and time questionnaire. Articles were selected based on strict inclusion and exclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses workflow was employed to represent the number of included and excluded articles. The risk of bias was analysed using the Joanna Briggs Institute Critical Appraisal Checklist. From the included articles, the following information was extracted: demographics, concurrent medical conditions, characteristics of florid cemento-osseous dysplasia (clinical, radiographic and histological), interventions performed on the edentulous sites (placement of implants or removable prostheses), outcomes after the interventions (complications, success, bone loss, implant loss and relapse) and follow-up period. Results: Six articles were included in the final analysis, and implants and removable prostheses were the devices reported to have been used to restore the edentulous sites. Eleven implants were placed in patients with florid cemento-osseous dysplasia, with a survival rate of 91%. Three out of three removable prostheses were delivered and all resulted in symptoms and required surgical interventions. Conclusions: Removable prostheses in patients with florid cemento-osseous dysplasia can present complications. Implant placement within the florid cemento-osseous dysplasia lesion is unpredictable and can result in radiolucency and implant loss; meanwhile, implant placement outside of the lesion has shown favourable medium-term results. Data are limited on the long-term efficacy of implants and removable prostheses in managing edentulous sites in patients with florid cemento-osseous dysplasia. Keywords: dental implants, edentulous sites, florid cemento-osseous dysplasia, removable dentures, systematic review This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. The authors have no competing interests to report.

Purpose: To evaluate the additional benefits of the adjunctive use of systemic antibiotics in the non-surgical and surgical treatment of peri-implantitis. Materials and methods: A systematic search following the population, intervention, comparison, outcome and study design framework was conducted across the MEDLINE (via PubMed), Embase and Web of Science databases. The primary outcome was probing depth reduction, and the secondary outcomes were bleeding on probing, clinical attachment level, radiographic bone level changes, suppuration and clinical success. Data on outcome variables were pooled through random effects meta-analyses. Results: Eight articles (seven studies) were included. For non-surgical interventions, systemic antibiotics reduced probing depth significantly after 1 year (n = 4; mean difference 1.33, 95% confidence interval 0.84 to 1.82; P 0.01), and also led to significant benefits in probing depth reduction at 3 and 6 months, clinical attachment level gain at 1 year (n = 3; mean difference 1.31, 95% confidence interval 0.68 to 1.95; P 0.01) and suppuration reduction at 3 months; however, no significant differences were found in bleeding on probing at 3 and 6 months, or clinical success at 1 year. For surgical treatment, antibiotics reduced probing depth significantly after 6 months, but no significant differences were noted after 1 year. Systemic antibiotics resulted in a significant increase in radiographic bone level after 1 year (n = 2; mean difference 0.96, 95% confidence interval 0.31 to 1.61; P 0.01) and a higher chance of clinical success (n = 2; odds ratio 2.16, 95% confidence interval 1.04 to 4.50; P = 0.009). In the combined analysis of non-surgical and surgical treatments for probing depth reduction at 1 year, systemic antibiotics showed a significant advantage (n = 5; mean difference 0.98, 95% confidence interval 0.56 to 1.40; P 0.01). Benefits extended to clinical attachment level gain, bone gain and increased likelihood of clinical success at 1 year. Conclusion: Non-surgical treatment of peri-implantitis with adjunctive systemic antibiotics led to significant benefits in probing depth reduction, clinical attachment level gain and suppuration reduction at 1 year. Surgical treatment with adjunctive systemic antibiotics showed significant benefits in terms of bone gain and clinical success at 1 year. Nevertheless, the variability in antibiotic protocols should be considered. The adjunctive use of systemic antibiotics should be evaluated with caution, as the benefits may not outweigh the risks of antibiotic resistance in less severe cases of peri-implantitis. Keywords: peri-implantitis, systematic review The authors declare there are no conflicts of interest relating to this study.

Purpose: To retrospectively evaluate the influence of mesiodistal intra-coronal cantilever width of implant-supported single crowns on the implant and restoration complication-free survival rate and the peri-implant soft and hard tissues. Materials and methods: A total of 142 patients with 179 implants in the posterior region were evaluated. The implants were divided into three groups according to intra-coronal cantilever width (Group 1, ≤ 1 mm; Group 2, 1 mm intra-coronal cantilever width 2 mm; Group 3, ≥ 2 mm). Marginal bone loss, complications and clinical parameters were used to evaluate the influence of intra-coronal cantilever width on implant-supported single crowns. Results: Group 1 included 95 implants, Group 2 was composed of 27 implants and Group 3 comprised 57 implants. A univariate Cox proportional hazards model, assessing implant complication-free survival, indicated a higher complication rate for Group 3 compared to Group 1 (P = 0.009). Furthermore, the marginal bone loss on the cantilever side over the short-term and medium- to long-term follow-up period indicated that intra-coronal cantilever width ≥ 2 mm may be considered a risk factor. From a clinical perspective, compared with Group 3, Groups 1 and 2 exhibited lower incidence rates of bleeding on probing during the medium- to long-term follow-up period (P = 0.003). Conclusions: Despite its limitations, the present study shows that posterior single implant crowns with mesiodistal intra-coronal cantilevers equal to or higher than 2 mm will present greater marginal bone loss, complications and tissue inflammation. Keywords: complications, dental implants, implant-supported single crowns, intra-coronal cantilever, marginal bone loss Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study.

Purpose: Zygomatic implants are considered one of the last options for the rehabilitation of severe maxillary atrophy when standard implants cannot be placed. They offer several advantages but can also present complications. This study aimed to investigate the long-term clinical and radiographic outcomes of zygomatic implant placement. Materials and methods: A retrospective chart review was conducted, and the inclusion criteria consisted of patients previously treated with zygomatic implants who had Class V or VI maxillary bone atrophy according to Cawood and Howell, and with a minimum follow-up period of 2 years after prosthetic loading. Outcome measures included implant and prosthesis survival rate, biological and biomechanical complications, and Lund-Mackay staging score before and after implant placement. Results: The study included 78 patients who received a total of 274 zygomatic implants. The mean follow-up period was 90.4 ± 26.0 months. Seventeen implant failures occurred, resulting in a survival rate of 93.8%, with a statistically significant negative correlation with smoking habits (P = 0.049), anchorage to the two zygomatic bone cortices (bicorticality) (P 0.001) and soft tissue complications (P 0.001). The prosthetic success rate was 92.3%. A statistically significant increase in maxillary sinus radiopacity was recorded when comparing the situation before and after surgery (P 0.001), and the intrasinus pathway had a statistically significant influence on that increase (P = 0.003). Conclusions: Zygomatic implants utilised for rehabilitating patients with severe maxillary atrophy have shown favourable outcomes. Nonetheless, owing to potential complications, strict case selection is necessary, combined with regular recall visits and proper oral hygiene maintenance. Furthermore, this type of surgery necessitates specialised training and expertise on the part of the practitioner. Keywords: bone atrophy, complications, long-term results, zygomatic implants The authors declare there are no conflicts of interest relating to this study.

Case presentation: Although most peri-implant lesions feature a combined defect configuration that involves both supra- and infraosseous components, regenerating the supraosseous part is considered the optimal approach, albeit a challenging one, and often requires vertical bone augmentation. This report provides a detailed description of submerged membrane techniques for vertical bone augmentation around supraosseous peri-implant defects. Cases involving different types of membrane (both resorbable and non-resorbable) with or without the use of bone graft are presented. In the first case, the patient had a mild supraosseous defect that was managed using the sausage technique with collagen matrix soaked with human recombinant bone morphogenetic protein-2. In cases two to five, titanium-reinforced dense polytetrafluoroethylene membranes were employed. Conclusion: The reconstruction of supraosseous peri-implant defects is technique sensitive but can be achieved when adhering to the principles of space maintenance and submerged healing. Keywords: bone regeneration, dental implants, human recombinant bone morphogenetic protein-2, peri-implantitis, supraosseous defects The authors declare there are no conflicts of interest relating to this study.