Libros

Purpose: To longitudinally assess the prevalence of peri-implant health, peri-implant mucositis and peri-implantitis in a cohort of patients with and without history of periodontitis over a 20-year period. Materials and methods: Eighty-four patients who attended a specialist private periodontal practice were evaluated prospectively 10 and 20 years after prosthesis delivery. Following successful completion of periodontal/implant therapy, patients (172 implants) were enrolled on an individualised supportive periodontal care programme. Clinical and radiographic parameters were collected to assess the prevalence of peri-implant health and diseases. Prevalence of peri-implantitis and peri-implant mucositis was calculated based on the case definition set out in 2018. A multilevel logistic regression analysis was conducted to assess potential risk or protective factors. Results: The analysis was performed on 22 periodontally healthy and 62 periodontally compromised patients rehabilitated with 39 and 130 implants, respectively. The 10-year prevalence of peri-implant health, peri-implant mucositis and peri-implantitis was 21.4%, 67.9% and 10.6%, respectively, whereas the 20-year prevalence was 29.8%, 47.6% and 33.3%, respectively. Non-compliant periodontally compromised patients showed a statistically significantly increased risk at 20 years of both peri-implant mucositis (odds ratio 11.1; 95% confidence interval 1.8–68.6) and peri-implantitis (bone loss and probing depth) (odds ratio 14.3; 95% confidence interval 1.8–32.9). High full-mouth plaque and bleeding scores were associated with higher odds of both peri-implant mucositis and peri-implantitis. Conclusions: Peri-implant diseases were prevalent in patients rehabilitated with dental implants and followed up for a period of 20 years. History of periodontal disease and a lack of compliance with a tailored supportive periodontal care programme were identified as risk factors for peri-implant diseases. Palabras clave: dental implants, peri-implantitis, periodontally compromised patients, periodontitis, supportive periodontal care The authors declare no potential conflict of interests with respect to this study. The study was self-funded; no external funding was available for this research.

For several years, the need for keratinized mucosa (KM) to reduce the risk of peri-implant biological complications has been a controversial topic. Recently, several studies and systematic reviews have confirmed that adequate KM may favorably impact peri-implant health and stability in the long-term. This article will review the recent literature on this topic and suggest clinical guidelines for when to increase peri-implant KM to facilitate surgical handling and enhance long-term maintenance. In conclusion, clinicians should keep in mind that a free gingival graft to increase the width of KM before implant placement may be indicated in situations where the soft tissue is so thin that its manipulation could be particularly difficult, as well as when an implant is already present, but patient reports soreness during oral hygiene procedures. Palabras clave: Free gingival graft, dental implant, keratinized mucosa, supportive care

The aim of this study was to investigate the long-term clinical conditions of periodontally compromised teeth treated by means of orthodontics after periodontal regeneration (GTR). Forty-eight patients affected by severe periodontitis who presented at least one nonmolar, malpositioned tooth with a pocket depth (PD) ≥ 7 mm, were consecutively enrolled in a private specialist practice. The treatment consisted of the following steps: infection control, provisional splinting, GTR, orthodontic treatment, final splinting, and supportive periodontal therapy (SPT). Thirty-six patients completed the 10-year study, as 12 were lost to follow-up. The total number of sites with PD ≥ 7 mm decreased from 25.4 ± 16.7 to 1.8 ± 2.1. PD of the teeth involved in the orthoperio treatment significantly decreased from 6.3 ± 1.5 mm to 3.1 ± 0.6 mm. One test tooth had to be extracted before the final examination due to root fracture, while two teeth lost vitality and received a root canal treatment. Eight episodes of recurrence, which required additional treatment, occurred during the 10 years of follow-up. The results of this study suggest that if a periodontal infection is under control, the orthodontic treatment does not reduce the long-term benefits of periodontal regeneration, even where the disease has caused massive tissue destruction.

The purpose of this study was to evaluate the long-term clinical outcomes around implants placed in sites previously augmented with demineralized bovine bone mineral with 10% collagen (Bio-Oss Collagen, Geistlich). In this prospective study, 36 consecutive, healthy patients, in need of a single-tooth extraction (incisors, canines, and premolars) and implant replacement, were included. After tooth extraction, Bio-Oss Collagen was inserted in the socket and covered either with a double layer of collagen membrane (test) or with a few drops of a flowable polylactide polymer (control). Following a healing period of 4 to 6 months, a single nonsubmerged implant surgery was performed. After cementation of a single ceramic crown, patients were asked to follow an individualized supportive periodontal therapy program. Clinical and radiographic data were obtained after prosthesis delivery (baseline) and at the 10-year follow-up visit. At the 10‑year examination, two patients were lost to follow-up. All implants demonstrated healthy peri-implant soft tissues as documented by standard parameters (full-mouth plaque score, full-mouth bleeding score, local bleeding on probing) in both groups. Mean soft tissue recession (REC) was 0.39 ± 0.54 mm for the test group and 0.50 ± 0.33 mm for the control, with no significant difference between the two groups. The results of this prospective study confirmed the long-term stability of the peri-implant marginal soft tissues supported by regenerated bone by means of the described technique using Bio-Oss Collagen. If the patient is properly followed throughout time, the risk for mucosal recession is low, with 1 mm of mean REC after 10 years.

Objectives: Clinical studies to assess dental implants are common in implantology, but such studies are usually performed for specific indications and following a specific protocol with strict inclusion and exclusion criteria. The aim of the current study was to evaluate the Straumann Bone Level SLActive dental implant in a prospective, multicenter, noninterventional trial. Method and Materials: The implant could be used in whatever manner was deemed suitable by the clinician, within approved indications. No particular placement or loading protocol was specified. A total of 1,532 implants were placed in 852 patients in 123 centers in nine countries in the US and Europe. After exclusion of three countries due to patient enrollment and data issues, 759 patients with 1,355 implants were analyzed. Results: Most patients received one or two implants (58.6% and 25.3% of patients, respectively), and 90% of cases were performed with a raised flap. A submerged healing protocol was significantly more prevalent in European centers, while transmucosal healing was significantly more prevalent in North American centers. After 1 year, 538 patients with 908 implants were available for evaluation. The cumulative implant survival and success rates were 98.5% and 96.0%, respectively. Conclusions: This prospective noninterventional study evaluated the use of Straumann Bone Level SLActive dental implants in a large number of patients. The cumulative survival and success rates were similar to those observed in controlled clinical trials, confirming this dental implant's clinical applicability in daily practice. Palabras clave: bone level dental implant, daily dental practice, noninterventional study, SLActive

Purpose: To evaluate the success and survival of immediately placed tapered implants to support fixed restorations in the maxilla and mandible. Materials and Methods: The study was a prospective, multicenter, non-interventional study of patients requiring tooth extraction who requested an implant-supported restoration in the maxilla or mandible. Patients received at least one tapered implant (either immediately after tooth extraction or at a later time point). Abutments were placed 42 to 56 days after surgery, and prostheses were placed after a further 14 days. Treatment and implant success were the primary effectiveness criteria, and secondary parameters included radiographic bone loss, patient satisfaction, and gingival health. Results: A total of 436 patients were enrolled, of whom 376 were included in the safety analysis. Single implants were placed in 77% of patients, two implants in 16%, and three or more implants in the remainder. The cumulative implant survival rates for immediately placed implants were 98.3% after 1 year and 97.7% from 2 to 5 years. Patient satisfaction was good or excellent in most patients and the majority of implants showed no or 1-mm change in bone level for up to 5 years. Conclusions: The survival rate of immediately placed tapered implants was comparable to that found in other studies. Immediate implant placement with tapered implants can allow rapid rehabilitation with no adverse impact on implant survival. Palabras clave: dental implants, extraction socket, healing, immediate implants

The aim of this multicenter, randomized controlled trial was to compare the clinical outcomes of a connective tissue graft (CTG) alone or in combination with enamel matrix derivative (CTG + EMD) in the treatment of Miller Class I and II gingival recessions. The 56 selected defects were evaluated for probing depth, recession depth, keratinized tissue width, and probing attachment level, and were measured at baseline and 12 months after treatment. The mean recession reduction was 3.9 ± 0.8 mm for EMD-treated sites (test) and 3.6 ± 1.5 mm for the control group (P = .22), corresponding to a mean root coverage of 90% and 80% for test and control groups, respectively (P = .05). Complete root coverage was obtained in 62% of test sites compared to 47% in the control group (P = .27). Both procedures provided good soft tissue coverage. The better results of the test group did not achieve a statistically significant level.

Purpose: To evaluate early and immediate loading of implants in the posterior maxilla and to investigate whether there is a difference in success rates, survival rates, and peri-implant parameters, including marginal bone level changes. Materials and Methods: A comprehensive systematic review of the literature was conducted. The selection of publications reporting on human clinical studies was based on predetermined inclusion criteria and was agreed upon by two reviewers. Results: Twelve papers were identified on early loading (two randomized controlled clinical trials [RCTs] and 10 prospective case series studies). Six papers were found on immediate loading (one RCT, four prospective case series, and one retrospective study). Conclusions: Under certain circumstances it is possible to successfully load dental implants in the posterior maxilla early or immediately after their placement in selected patients. The success rate appears to be technique sensitive, although no study has directly assessed this. A high degree of primary implant stability (high value of insertion torque) and implant surface characteristics play an important role. It is not possible to draw evidence-based conclusions concerning contraindications, threshold values for implant stability, bone quality and quantity needed, or impact of occlusal loading forces. As for the impact of the surgical technique on implant outcome in different bone densities, no studies prove significant superior results with one technique over another. Well-designed RCTs with a large number of patients are necessary to make early/immediate loading protocols in posterior maxilla evidence based, but ethical and practical considerations may limit the real possibility of such studies in the near future. Palabras clave: dental implants, fixed dental prostheses, loading protocol, partial edentulism, posterior maxilla, single crown, systematic review

Purpose: To evaluate the predictability of early and immediate loading protocols of implants in the posterior mandible and to investigate whether there is a difference in success rates, survival rates, and peri-implant parameters, including marginal bone level changes, between loading protocols. Materials and Methods: A comprehensive systematic review of the literature was conducted. The selection of publications reporting on human clinical studies was based on predetermined inclusion criteria and was agreed upon by two reviewers. Results: A total of 19 papers were selected: 8 on early loading, 9 addressing immediate loading, and 2 comparing immediate and early loading. Of the 19 studies, 5 were randomized clinical trials and 14 were prospective studies. Conclusions: Existing literature supports the early loading of microroughened dental implants in the partially edentulous posterior mandible at 6 to 8 weeks in the absence of modifying factors. Therefore, loading within this time frame can be considered routine for the majority of clinical situations in the posterior mandible, either with single crowns or fixed dental prostheses. Immediate loading of microroughened dental implants in the partially edentulous posterior mandible proved to be a viable treatment alternative. Caution is necessary when interpreting published outcomes for immediate loading, as the inclusion exclusion criteria are inconsistent and many subjective confounding factors are evident. Additional studies with longer follow-ups, specifically randomized clinical trials, are needed to consolidate the data for immediate loading. Priority should be given to trials testing immediate loading. Palabras clave: dental implants, fixed dental prostheses, loading protocol, partial edentulism, posterior mandible, single crown, systematic review