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Purpose: To assess the implant failure rate and clinical and radiographic outcomes of implants affected by peri-implantitis that received surgical treatment. Materials and methods: A systematic search was conducted of three databases (PubMed, Embase and Cochrane Library) to identify studies that examined implant failure and biological outcomes after surgical peri-implantitis treatment, including ≥ 10 patients and reporting on a follow-up period of at least 12 months. Data and risk of bias were assessed qualitatively and quantitively. Surgical modalities were subdivided into reconstructive, non-reconstructive and combined. Meta-analyses were performed for implant failure, marginal bone level and probing pocket depth at 12 and 36 months with the respective subset of available data for each time and endpoint. Results: A total of 45 studies with 3,463 treated implants were included in the quantitative evaluation. Meta-analyses revealed low implant failure rates of 1.2% (95% confidence interval 0.4%, −2.1%) and 4.2% (95% confidence interval 1.0%, −8.8%) at 12 and 36 months, respectively. No significant difference between the subgroups was observed at 12 months. At 36 months, reconstructive modalities showed a significantly lower implant failure rate (1.0%; 95% confidence interval 0.0%, 5.0%; P = 0.04, χ2(1) = 4.1) compared to non-reconstructive modalities (8.0%; 95% confidence interval 2.0%, 18.0%). The mean probing pocket depth was 3.71 mm (95% confidence interval 3.48, 3.94 mm) at 12 months and 3.63 mm (95% confidence interval 3.02, 4.24 mm) at 36 months. The mean marginal bone loss was 3.31 mm (95% confidence interval 2.89, 3.74 mm) at 12 months and 2.38 mm (95% confidence interval 1.01, 3.74 mm) at 36 months. No significant differences between the modalities were observed for bleeding on probing after either of these time points. Cumulative interventions during supportive therapy were reported in 9% of the studies. Conclusion: Surgical treatment of peri-implantitis results in a low implant failure rate in the short and medium term. No differences were noted between the different interventions with regard to failure rate. Surrogate therapeutic endpoints were improved after treatment, without significant differences between the different modalities. Therapeutic success and/or disease resolution and cumulative interventions during supportive therapy are seldom reported in the literature, but limited long-term outcomes are documented consistently. Keywords: failure, non-reconstructive therapy, peri-implantitis, reconstructive therapy, surgical procedure The authors report no conflicts of interest relating to this study.

Purpose: To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction. Materials and methods: A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evalu-ated by all participants. After the forms were completed, the responses were sent for blinded ana-lysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned. Results: After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement. Conclusion: This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of bucco-palatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable. Keywords: diagnostic procedure, implant dentistry, lateral window technique, pterygoid implants, sinus floor elevation, transcrestal sinus floor elevation, zygomatic implants The authors report no conflicts of interest relating to this study.

Purpose: The aim of this study was to evaluate suppuration on palpation, used as a diagnostic test, in the detection of peri-implantitis. Materials and methods: A total of 65 patients with 267 implants were examined. Clinical inspection was performed by two blinded examiners: The first measured suppuration on palpation, and the second conducted a complete clinical examination. A third examiner combined the previously collected information with radiographic data and diagnosed the patients according to the European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification system. Calibration was conducted previously to the fourth examiner on a set of five patients not belonging to the study sample. Results: When suppuration on palpation was associated with diagnosis of peri-implantitis, the specificity and negative predictive value were high (88% and 84%, respectively), meaning that an implant that was negative to suppuration on palpation had a high chance of not being affected by peri-implantitis. Conversely, the sensitivity and positive predictive value were low (45% and 54%), demonstrating that a suppurating implant will be affected by peri-implantitis in only half of the cases. Area under the curve was calculated as 60.4 (P = .012), and accuracy was found to be 78%. Conclusion: Suppuration on palpation alone, as with any other clinical sign, does not allow a precise diagnosis of peri-implantitis. An implant without suppuration on palpation shows a high chance of being free of peri-implantitis, while an implant that suppurates upon palpation is not necessarily affected by peri-implantitis. Suppuration on palpation may be a valuable clinical sign, especially when evaluating implants that are difficult to examine via probing. Keywords: bacteria, biologic complications, cross-sectional study, diagnostic procedure, peri-implantitis, suppuration

The present clinical report describes a treatment strategy for transition from full-arch restorations supported either partially or fully by failing implants that need to be removed. More specifically, the staged approach proposes a deferred treatment sequence in which the failing implants or teeth are not all replaced simultaneously. With this technique, some failing natural or artificial abutments are preserved momentarily in order to maintain the patient with a fixed provisional restoration at all times throughout the execution of treatment, from the surgical phase until delivery of the final restoration. The present clinical report describes the staged approach in detail, compares it to other treatment options, and illustrates all phases of therapy with a clinical case.

Purpose: To describe the prevalence of alveolar bone atrophy in edentulous arches of elderly individuals in relation to insertion of dental implants and the eventual need for bone grafting procedures. Materials and Methods: Computed tomography scan files of 228 edentulous arches of elderly patients (ages 65 to 100 years) were evaluated in relation to implant placement. Six measurements per arch were taken on cross-sectional reconstructions. Bone atrophy categories were described, in relation to implant placement, for the anterior and posterior sections of the arches. Six bone sections per arch were evaluated and allocated to the predetermined categories. Prevalence of each type of atrophy was calculated. Results: In the maxilla, only 5.0% of the patients showed a bone anatomy capable of receiving implants without any augmentation both in the posterior and anterior regions; 64.4% showed the need for major reconstruction in both areas. In the mandible, 17.3% of the patients did not require any augmentation in both regions; 9.4% were in need of major reconstruction in both areas. The anterior part of the arches could eventually be treated without any bone augmentation in 10.9% of the maxillae and 72.4% of the mandibles, while minor augmentation was needed in 16.8% of maxillae and 15.8% of mandibles. Conclusion: Most edentulous elderly patients show some degree of alveolar bone atrophy. It is often feasible to insert implants in the anterior mandible to support a restoration. In most maxillary cases, alveolar atrophy calls for augmentation procedures in both the anterior and posterior areas. In elderly individuals, the anterior maxilla often shows bone deficiency interfering with simple implant placement procedures, thus also limiting the use of tilted implants. Keywords: bone atrophy, dental implants, edentulous arches, elderly population

Purpose: There is a lack of studies reporting long-term prevalence of peri-implant diseases in patients rehabilitated with overdentures and not receiving maintenance, which is a common situation. The aim of this cross-sectional study was to evaluate the patient satisfaction and rate of biologic complications in patients rehabilitated at least 7 years before with mandibular/maxillary overdentures, who for personal or economic reasons decided not to participate in a structured supportive maintenance program. Materials and Methods: Each of the patients filled out a health and dental history and a visual analog scale (VAS)-based satisfaction questionnaire; additionally, the patients received a clinical examination and a panoramic radiograph. The prevalence of peri-implant diseases and the patient satisfaction were reported. Moreover, presumed risk indicators of peri-implant diseases and implant loss were tested through univariate analyses and multivariate, time-adjusted, logistic regressions. Results: A total of 52 patients who received 63 overdentures on 252 implants were included. The included patients showed a high degree of satisfaction (mean VAS = 6.3; SD: 2.1) and very low discomfort rates and would repeat the type of rehabilitation (mean VAS = 6.99; SD: 2.6). The prevalence of peri-implantitis was 30.8% at patient level and 19.4% at implant level, while 23.1% of patients experienced implant loss at any time. A clear tendency toward increased prevalence of biologic complications after the eighth year of loading was noted. In loading time-adjusted regression analyses, bone-level implants were associated with a higher prevalence of recession with no/minimal inflammation (OR = 3.37; 95% CI: 1.16 to 9.77; P = .025), while the maxillary arch was associated with both severe peri-implantitis (OR = 4.18; 95% CI: 1.03 to 16.97; P = .046) and implant loss (OR = 9.27; 95% CI: 3.41 to 25.14; P = .000). Conclusion: Despite high levels of satisfaction, patients rehabilitated with overdentures not participating in a structured supportive schedule show high rates of biologic complications. For this reason, they should be strongly motivated, at the time of prosthesis delivery, to participate in a structured maintenance program. Keywords: long term, patient satisfaction, peri-implant diseases, peri-implantitis, peri-implant mucositis, risk factors, supportive

Bei Rehabilitationen des gesamten Kiefers ist besonders die Phase der provisorischen Versorgung wichtig für die Bestimmung der korrekten individuellen Okklusion, Kieferrelation und Ästhetik des Patienten. Dabei ist es schwierig, diese Informationen auf die definitive Restauration zu übertragen. Es gibt bereits mehrere Techniken, mit denen die Informationen von festsitzenden zahnoder implantatgetragenen Provisorien auf definitive Restaurationen übertragen werden können. Im vorliegenden Beitrag wird der Vorschlag der Autoren für eine Technik beschrieben, mit deren Hilfe Informationen von herausnehmbaren Prothesen auf implantatgetragenen Zahnersatz übertragen werden können.

When dealing with full-arch rehabilitation, the provisional phase is important in order to define the correct occlusal, intermaxillary, and esthetic relationships for each individual patient. In these cases, it is difficult to transfer this information to the final restorations. Several techniques have been developed to transfer the information from tooth- or implant-supported fixed provisionals to the definitive rehabilitations. The present article describes a technique proposed by the authors to transfer the information from a removable prosthesis to an implant-supported restoration.

Objective: The rehabilitation of edentulous mandibles with implant-supported overdentures is a state-of-the-art contemporary implant treatment. Computer-assisted flapless surgery is associated with decreased chairside treatment time, as well as significant reduction in patient postoperative morbidity and discomfort. The aim of this study was to evaluate the protocol of computer-guided surgery in the treatment of edentulous mandibles with overdentures supported by four intraforaminal implants and retained by Locator® attachments in elderly patients, both from a clinician's and a patient's perspective, as well as to assess the stability of the results in a 2-year period. Method and Materials: 15 patients presenting edentulous mandibles and discomfort while wearing conventional overdentures were enrolled in the study. Careful presurgical and computer-assisted 3D treatment planning was performed. Patients were treated with four intraforaminal implants using a computer-assisted flapless approach. All patients were prosthetically rehabilitated with overdentures. Clinical parameters such as peri-implant probing depth (PPD), Plaque Index (PI), and bleeding on probing (BOP) were evaluated. Patients' perceptions regarding the outcome were assessed on visual analog scales (VAS). Results: Out of 15 patients consecutively included in the study, only 10 patients could be treated with the designed protocol. A total of 40 Camlog implants were placed. No implant was lost over a 2-year period. BOP was negative in 82% of sites; mean PPD was 2.34 mm; 8 of the 40 implants showed the absence of keratinized tissue on the lingual or the vestibular aspect. The VAS score of 9.9 demonstrated the satisfaction of the patients. Conclusions: Within the limitations of this study, the data demonstrate that in a significant number of cases this protocol could not be used for anatomical or technical reasons. In the cases where it could be used, the computer-assisted protocol appeared suitable for treating elderly patients with mandibular edentulism and restoring them with an overdenture in a minimally invasive way. The possibility of placing implants outside the borders of the keratinized tissue is relevant. Keywords: flapless surgery, guided surgery, overdenture