Background: The advent of osseointegration and advances in biomaterials and techniques have contributed to increased application of dental implants in the restoration of partial and completely edentulous patients. Often, in these patients, soft and hard tissue defects result from a variety of causes, such as infection, trauma, and tooth loss. These create an anatomically less favorable foundation for ideal implant placement. For prosthetic-driven dental implant therapy, reconstruction of the alveolar bone through a variety of regenerative surgical procedures has become predictable; it may be necessary prior to implant placement or simultaneously at the time of implant surgery to provide a restoration with a good long-term prognosis. Regenerative procedures are used for socket preservation, sinus augmentation, and horizontal and vertical ridge augmentation.Methods: A broad overview of the published findings in the English literature related to various bone augmentation techniques is outlined. A comprehensi...

Bone augmentation techniques.

This review discusses and summarizes the recent developments and advances in the use of biodegradable materials for bone repair purposes. The choice between using degradable and non-degradable devices for orthopedic and maxillofacial applications must be carefully weighed. Traditional biodegradable devices for osteosynthesis have been successful in low or mild load bearing applications. However, continuing research and recent developments in the field of material science has resulted in development of biomaterials with improved strength and mechanical properties. For this purpose, biodegradable materials, including polymers, ceramics and magnesium alloys have attracted much attention for osteologic repair and applications. The next generation of biodegradable materials would benefit from recent knowledge gained regarding cell material interactions, with better control of interfacing between the material and the surrounding bone tissue. The next generations of biodegradable materials for bone repair and regeneration applications require better control of interfacing between the material and the surrounding bone tissue. Also, the mechanical properties and degradation/resorption profiles of these materials require further improvement to broaden their use and achieve better clinical results.

/pdf/biodegradable-materials-for-bone-repair-and-tissue-4qwxkc6tvq.pdf

Biodegradable Materials for Bone Repair and Tissue Engineering Applications

The aim of this article was to review the literature on differential diagnosis and treatment of biologic complications and failing implants All types of publications, with the exception of abstracts, published in English up to December 1998, were included A multi-layered search strategy was used Controlled clinical trials (CCTs) were searched in the Cochrane Oral Health Group's Specialized Register of Trials This database contains all CCTs identified in MEDLINE and EMBASE PubMed was searched using various key words and the "related articles" feature All identified publications were obtained and none were excluded Infection, impaired healing, and overload are considered the major etiologic factors for the loss of oral implants Only a few clinical and animal investigations were found that tested the validity of the proposed therapeutic approaches The treatment of failing implants is still based mainly on empirical considerations, often derived from periodontal research, from data extrapolated from in vitro findings, or from anecdotal case reports performed on a trial-and-error basis

https://coimplante.odo.br/Biblioteca/Complicacoes/Biologic%20Complications%20and%20Failing%20Oral%20Implants%20-%20Esposito%20et%20al.pdf

Differential diagnosis and treatment strategies for biologic complications and failing oral implants: a review of the literature.

Peri-implant diseases are defined as inflammatory lesions of the surrounding peri-implant tissues and include peri-implant mucositis (an inflammatory lesion limited to the surrounding mucosa of an implant) and peri-implantitis (an inflammatory lesion of the mucosa that affects the supporting bone with resulting loss of osseointegration). This review aims to describe the different approaches to manage both entities and to provide a critical evaluation of the evidence available on their efficacy. Therapy of peri-implant mucositis and nonsurgical therapy of peri-implantitis usually involve mechanical debridement of the implant surface using curettes, ultrasonic devices, air-abrasive devices or lasers, with or without the adjunctive use of local antibiotics or antiseptics. The efficacy of these therapies has been demonstrated for mucositis: controlled clinical trials show an improvement in clinical parameters, especially in bleeding on probing. For peri-implantitis, the results are limited, especially in terms of probing pocket-depth reduction. Surgical therapy of peri-implantitis is indicated when nonsurgical therapy fails to control the inflammatory changes. Selection of the surgical technique should be based on the characteristics of the peri-implant lesion. In the presence of deep circumferential and intrabony defects, surgical interventions should aim to provide thorough debridement, implant-surface decontamination and defect reconstruction. In the presence of defects without clear bony walls or with a predominant suprabony component, the aim of the surgical intervention should be the thorough debridement and the repositioning of the marginal mucosa to enable the patient to perform effective oral-hygiene practices, although this aim may compromise the esthetic result of the implant-supported restoration.

/pdf/management-of-peri-implant-mucositis-and-peri-implantitis-598yo5o6lc.pdf

Management of peri-implant mucositis and peri-implantitis.

The purpose of this randomized clinical trial was to compare the clinical outcome of two different surgical approaches for the treatment of peri-implantitis. Seventeen patients with ITI(R) implants were included consecutively over a period of 5 years. The patients were randomized with a lottery assignment. Ten patients were treated with resective surgery and modification of surface topography (test group). The remaining seven patients were treated with resective surgery only (control group). Clinical parameters (suppuration, modified plaque index - mPI, modified bleeding index - mBI, probing pocket depth - PPD, pseudopocket - DIM, mucosal recession - REC, probing attachment level - PAL) were recorded at baseline, as well as 6, 12, 24 and 36 months after treatment. The cumulative survival rate for the implants of the test group was 100% after 3 years. After 24 months, two hollow-screw implants of control group were removed because of mobility. Consequently, the cumulative survival rate was 87.5%. The recession index in the control group was significantly lower than in the test group at 24 months (Student's t-value of -2.14). On the contrary, control group showed higher PPD, PAL and mBI indexes than test group (Student's t-values of +5.5, +2.4 and +9.61, respectively). The PPD and mBI indexes for the implants of the control group were significantly higher at baseline than 24 months later (Student's t-values of +3.18 and +3.33, respectively). Recession and PAL indexes resulted in values significantly lower than baseline (Student's t-values of -4.62 and -2.77, respectively). For the implants of the test group PPD and mBI indexes were significantly higher at baseline than 36 months after (Student's t-values of +11.63 and +16.02, respectively). Recession index resulted in values significantly lower at baseline (Student's t-value of -5.05). No statistically significant differences were found between PAL index measurement at baseline and 36 months later (Student's t-value of +0.89). In conclusion, resective therapy associated with implantoplasty seems to influence positively the survival of oral implants affected by inflammatory processes.

Therapy of peri-implantitis with resective surgery. A 3-year clinical trial on rough screw-shaped oral implants. Part II: radiographic outcome.

In the midto late Seventies, Tatum (1977) reported on a procedure of sinus elevation to enable dental implants to be placed in the maxilla where insufficient bone was present due to sinus enlargement. Clinically, this procedure has shown some promise. To date, Lozada and James (1988) have been able to report on tissue recovered with a trephine from a sinus elevation site at the time of implant placement. This report investigates the response to resorbable hydroxylapatite OSTEOGEN@ (HA Resorb )@, Impladent Ltd., Holliswood, NY) combined with freeze-dried demineralized cortical bone powder (Southern California Neuroskeletal Tissue Bank, San Bernardino, CA) implanted during a sinus elevation and carried out simultaneously with root-form dental implantation.

Histological response and clinical evaluation of heterograft and allograft materials in the elevation of the maxillary sinus for the preparation of endosteal dental implant sites. Simultaneous sinus elevation and root form implantation: an eight-month autopsy report.

Surgical repair of peri-implant defects.

This paper presents post mortem histologic specimens of the implant/osseous tissue interface from a patient who had had simultaneous bilateral maxillary sinus augmentation and root-form implant placement eight months prior. Two implants were observed: One implant was totally submerged in bone and graft material (2E), and other implant (3E) was devoid of bone at the apex. Microscopic examination revealed that a bony interface existed around implant 2E but that implant 3E had minimal bony interface. It is suggested that the minimal bony interface was the result of minor implant movement induced by variations in barometric pressure on the apex of implant 3E, and that eight months would not have been enough healing time prior to loading for this patient.

The histologic evaluation of the implant interface with heterograft and allograft materials--an eight-month autopsy report, Part II.

It has been noted that overloading of an implant can lead to the premature loss of implants (Jones et al., 1979; Travis and Jones, 1986). An understanding of the mechanism by which subperiosteal implants support masticatory loads could lead to appropriate design changes for best utilization of this mechanism and thus increase the predictability of subperiosteal implants (James, 1983). This study attempts to analyze the suspension mechanism in implants recovered from a baboon after 10 years' use.

Suspension mechanism of subperiosteal implants in baboons.

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Histological response and clinical evaluation of heterograft and allograft materials in the elevation of the maxillary sinus for the preparation of endosteal dental implant sites. Simultaneous sinus elevation and root form implantation: an eight-month autopsy report.

Surgical repair of peri-implant defects.

The histologic evaluation of the implant interface with heterograft and allograft materials--an eight-month autopsy report, Part II.

Suspension mechanism of subperiosteal implants in baboons.