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Esthetic implant complication. A, Bone dehiscence associated with inadequate implant position and thin mucosal phenotype led the case to an esthetic failure (frontal view). B, Occlusal view after crown removal. C, Implant removal was cautiously executed using reverse torque. D, Collagen matrix (Mucograft; Geistlich Pharma, Wolhausen, Switzerland) was used to seal the socket. No bone substitute material was used for grafting. E, Frontal view 8 weeks after implant removal. E, Frontal view 8 weeks after implant removal. F, Occlusal view 8 weeks after implant removal. G, Surgical entry 8 weeks after implant removal. Note the three‐wall defect that may enable the achievement of primary stability and where hard and soft‐tissue grafting are encouraged for successful esthetic outcomes. H, Occlusal view of reference pin used during implant placement. I, Implant was placed in the adequate three‐dimensional position to achieve optimal esthetic outcomes. J, Autogenous bone harvested from the neighboring alveolar bone was used as grafting material combined with, K, slow resorbable bone substituted (Bio‐Oss; Geistlich Pharma, Wolhausen, Switzerland). L, Resorbable membrane was used to fulfill cellular occlusivity (Creos xenoprotect; Nobel Biocare AG, Kloten, Switzerland). M, Clinical and, N, radiographic stability was noted 12 months after implant placement
Source publication
Inappropriate and unnecessary implant therapy driven by an erroneous belief that dental implants provide enhanced function and esthetics over diseased or failing teeth has led to a growing burden of implant complications across the globe. Specifically, esthetic and biological complications frequently lead to the unfavorable prognosis of dental impl...
Citations
... As the newly formed bone mass does not match the reabsorbed bone mass, the continued net loss of bone contact with the implant will damage osseointegration and eventually lead to the loss of the implant [8]. The clinical features of peri-implant diseases include erythema, bleeding, and pus spillage from the peri-implant mucosa, with or without bone loss, which seriously affect patients' quality of life and the longevity of implants while also posing a risk for the patients' overall health [15][16][17][18][19][20][21] However, the treatment of peri-implant diseases is known to be complex. Successful management of peri-implant mucositis, a reversible inflammatory condition, is crucial for preventing irreversible peri-implantitis [4,22]. ...
Objectives
Peri-implant diseases, being the most common implant-related complications, significantly impact the normal functioning and longevity of implants. Experimental models play a crucial role in discovering potential therapeutic approaches and elucidating the mechanisms of disease progression in peri-implant diseases. This narrative review comprehensively examines animal models and common modeling methods employed in peri-implant disease research and innovatively summarizes the in vitro models of peri-implant diseases.
Materials and methods
Articles published between 2015 and 2023 were retrieved from PubMed/Medline, Web of Science, and Embase. All studies focusing on experimental models of peri-implant diseases were included and carefully evaluated.
Results
Various experimental models of peri-implantitis have different applications and advantages. The dog model is currently the most widely utilized animal model in peri-implant disease research, while rodent models have unique advantages in gene knockout and systemic disease induction. In vitro models of peri-implant diseases are also continuously evolving to meet different experimental purposes.
Conclusions
The utilization of experimental models helps simplify experiments, save time and resources, and promote advances in peri-implant disease research. Animal models have been proven valuable in the early stages of drug development, while technological advancements have brought about more predictive and relevant in vitro models.
Clinical relevance
This review provides clear and comprehensive model selection strategies for researchers in the field of peri-implant diseases, thereby enhancing understanding of disease pathogenesis and providing possibilities for developing new treatment strategies.
... Various implant removal techniques have been proposed, including the counter-torque ratchet technique (CTRT), trephine drills, burs, piezosurgery, and laser surgery, either individually or in combinations, each offering distinct benefits, limitations, and overall success rates [13]. While reverse torque is considered conservative for peri-implant tissues, allowing potential immediate implant insertion, it may not be suitable for fractured implants, narrow implants (under 4 mm), or specific implant systems. ...
... This is explained by the way this technique engages the implant and reverses it out of the bone using a torque applied counterclockwise. Minimal bone loss results from shear stress application because it breaks the contact between the implant and bone interface [9,13]. This method is perhaps one of the most conservative methods, requiring little or no bone removal and causing minimal harm to the surrounding tissues [15]. ...
... This technique should be used only if the implant connection is intact and the implant is solid enough to be 'torqued out' without breakage. Implants with higher osseointegration should be removed using a combination of CTRT and a bone-cutting approach, such as trephine burs or piezoelectric bone cutters [9,13]. ...
... The first scenario involves mounting the graft components directly into the socket following tooth removal. During the second scenario, bone grafts are employed where teeth are unretained due to ridge resorption, making reconstruction necessary (Monje & Nart, 2022). These graft materials encourage bone regeneration by stimulating the body to produce new bone cells. ...
Background
The bone regeneration therapy is often used in patients with inadequate bone support for implants, particularly following tooth extractions. Xenografts derived from animal tissues are effective bone reconstructive options that resist resorption and pose a low risk of transmitting disease. Therefore, these implants may be a good option for enhancing and stabilizing maxillary sinuses. The purpose of this study was to compare two xenografts, Bone⁺B® and InterOss®, for the reconstruction of rabbit calvaria defects.
Methods and Materials
The study involved seven male New Zealand white rabbits. In the surgical procedure, 21 spots were created on both sides of the midline calvarium by creating three 8‐millimeter defects. A control group was used, as well as two treatment groups utilizing Bone⁺B® Grafts and InterOss® Grafts. After 3 months, the rabbits were euthanized, followed by pathological evaluation. Analysis of these samples focused on bone formation, xenograft remaining material, and inflammation levels, using Adobe Photoshop CS 8.0 and SPSS version 24.
Results
With the application of Bone⁺B® graft, bone formation ranged from 32% to 45%, with a mean of 37.80% (±5.63), and the remaining material ranged from 28% to 37%, with a mean of 32.60% (±3.65). Using InterOss® grafts, bone formation was 61% to 75%, the mean was 65.83% (±4.75), and the remaining material was 9% to 18%, with a mean of 13.17% (±3.06). The bone formation in the control group ranged from 10% to 25%, with a mean of 17.17% (±6.11). InterOss® had lower inflammation levels than other groups, but the difference was not statistically significant (p > .05).
Conclusion
InterOss® bone powder is the best option for maxillofacial surgery and bone reconstruction. This is due to more bone formation, less remaining material, and a lower inflammation level. Compared to the control group, Bone⁺B® improves healing and bone quality, thus making it an alternative to InterOss®.
... Implant removal is often the treatment of choice to effectively arrest peri-implantitis. 192 Cases in which the bone loss exceeds 50% of the total length of the infected implant or cases of disease recurrence are frequently indicated for implant removal due to its unfavorable prognosis. [193][194][195][196][197] A cross-sectional study 198 As with periodontitis, peri-implantitis is, in most situations, asymptomatic and not perceived by the patients. ...
Periodontal and peri‐implant diseases result from a chronic inflammatory response to dysbiotic microbial communities and are characterized by inflammation in the soft tissue and the ensuing progressive destruction of supporting bone, resulting in tooth or implant loss. These diseases' high prevalence, multifactorial etiology, extensive treatment costs, and significant detriment to patients' quality‐of‐life underscore their status as a critical public health burden. This review delineates the economic and sociocultural ramifications of periodontal and peri‐implant diseases on patient welfare and healthcare economics. We delve into the implications of diagnosis, treatment, supportive care, and managing destructive tissue consequences, contrasting these aspects with healthy patients.
... In conditions of lower severity, treatments ranged from site decontamination (debridement, polishing of the implant surface, laser decontamination) to implantoplasty (smoothening of the implant surface to reduce the risk of bacterial adhesion). Treatments for severe conditions ranged from regenerative procedures with autogenous bone and/or bone substitute materials [35][36][37] to the removal of the compromised implant and substitution with another implant subsequent to/in combination with bone regeneration procedures [38,39]. The last situation can be considered analogue to implant placement in post-extraction sockets of a compromised tooth affected by a wide periodontal defect. ...
... Trabecular metal (TM) implants with a machined collar were used in the following sizes: 3.7, 4.1, and 4.7 mm diameters and 10, 11.5, and 13 mm lengths (Zimmer Biomet Dental, Palm Beach Gardens, FL, USA). The diameter of the new TM implant was chosen to leave a bone wall thickness of at least 1.5 mm at the buccal and lingual/palatal side (39) (Figure 2b). After implant insertion, a porcine particulate with a granule size of 0.25 to 1 mm was used as bone grafting material (RegenerOss ® , Zimmer Biomet Dental) to fill the defect around implants until the desired ridge contour was established ( Figure 2c). ...
... Gardens, FL, USA). The diameter of the new TM implant was chosen to leave a bone wall thickness of at least 1.5 mm at the buccal and lingual/palatal side (39) (Figure 2b). After implant insertion, a porcine particulate with a granule size of 0.25 to 1 mm was used as bone grafting material (RegenerOss ® , Zimmer Biomet Dental) to fill the defect around implants until the desired ridge contour was established ( Figure 2c). ...
Background: Implant replacement is among the treatment options for severe peri-implantitis. The aim of this single-cohort study was to evaluate the feasibility of replacing compromised implants affected by advanced peri-implantitis with new implants with a porous trabecular metal (TM) structure. Materials and Methods: Patients with one or more implants in the posterior region showing a defect depth >50% of implant length, measured from the residual crest, were consecutively included. Two months after implant removal, patients received a TM implant combined with a xenograft and a resorbable membrane. The implant stability quotient (ISQ) was measured at placement and re-assessed five months later (at uncovering), then after 6, 12, and 24 months of function. Marginal bone loss was radiographically evaluated. Results: Twenty consecutive cases were included. One patient dropped out due to COVID-19 infection, and nineteen cases were evaluated up to 24 months. At placement, the mean ISQ was 53.08 ± 13.65 (standard deviation), which increased significantly to 69.74 ± 9.01 after five months of healing (p < 0.001) and to 78.00 ± 7.29 after six months of loading (p < 0.001). Thereafter, the ISQ remained stable for up to 24 months (80.55 ± 4.73). All implants successfully osseointegrated and were restored as planned. After two years, the average marginal bone level change was −0.41 ± 0.38 mm (95% confidence interval −0.60, −0.21), which was limited yet significantly different from the baseline (p < 0.05). Conclusions: The treatment of advanced peri-implant defects using TM implants inserted two months after explantation in combination with guided bone regeneration may achieve successful outcomes up to two years follow-up, even in the presence of low primary stability.
... Among the methods, the countertorque ratchet technique (CTRT) was most frequently used because it seems to be the most conservative technique and will allow the reinsertion of a new implant in the same site or close to it [32,34,35,39] (Fig. 2). This result has also been confirmed by other reviews on the subject, which consider this technique, when feasible, the first choice, despite the trephine drill technique being the better known [21,39,[45][46][47]. The counter-torque technique achieved a success rate of 87.7%. ...
... The literature demonstrates that placing a second implant either after implant failure or removal is favorable in terms of future implant survival [48]. A systematic review found that survival rates after a second attempt were approximately 88% over a mean follow-up period of about 40 months [45]. Simultaneous bone regeneration procedures and the use of a removal kit have significantly reduced the impact on dimensional changes, resulting in less discomfort for the patient and a better cost-benefit ratio [49]. ...
Background
Today dental implants represent an effective therapy in case of partial or total edentulism, with an excellent success rate. Despite the results obtained, there may be biological or mechanical complications during the therapy, which lead to the loss of the implant. This systematic review aims to evaluate the current state of the art in the literature on techniques used for the removal of dental implants. Various aspects will be analyzed, such as the success of the technique, any complications, and the advantages and disadvantages of their use.
Methods
Two reviewers conducted a literature analysis (PubMed, Embase, Web of Science) of the last 20 years (2003–2023). The main criterion analyzed was the success of the technique, while secondary outcomes such as complications and risks of the technique were also analyzed. 258 articles were identified in the various search databases. 42 eligible articles were subsequently identified after an article screening. Only 18 full texts were subsequently included in the review.
Results
A total of 18 articles were selected and 1142 implants and 595 patients were included. The main techniques used were the Counter-Torque Ratchet Technique (CTRT), Piezoelectric bone surgery (PBS), trephine drills, carbide burs, Erbium, Chromium, Yttrium, Scandium, Gallium, Garnett (Er:Cr:YSGG) laser and carbon dioxide (CO 2 ) laser. Combined uses of techniques have been identified such as: PBS and trephine burs or carbide burs, trephine burs with the use of a 3d-printed guide, CTRT and trephine burs. The technique with the highest success rate, less morbidity for the patient, and less removal of bone appears to be the CTRT.
Conclusions
The use of conservative techniques, especially CTRT, in bone removal is useful to allow for immediate implant placement in the removal area. However, further studies with a high sample size are needed to be performed on all techniques, particularly new randomized controlled trials (RCTs) that allow for the analysis of the success of alternative techniques such as Laser and Piezosurgery, which appear to be very promising.
... Implant failures due to biological complications or unsatisfactory esthetic outcomes very often originate from implant malpositioning or errors during implant surgery (Monje et al., 2016). Interestingly, peri-implantitis and esthetic failures are more commonly noted in the buccal aspects (Monje & Nart, 2022). Implants placed in healed sites must have an adequate buccal bone wall thickness (BBT) to ensure that the implant is circumferentially embedded in vital bone at the completion of bone healing. ...
Background
The significance on the association between the peri‐implant bucco‐lingual dimension (BLD) at the stage of implant placement and the occurrence of biological and esthetic complications is yet unknown.
Material and methods
Systematic screening of electronic sources was carried out to identify clinical and preclinical studies reporting on the baseline BLD and/or buccal bone thickness (BBT) values. A secondary objective was to assess the effect of simultaneous grafting at sites with deficient or no buccal bone wall (BBW) at baseline. The primary outcome variables were BBT, BLD, and buccal vertical bone loss (VBL) at re‐evaluation. Moreover, radiographic, clinical, and patient‐reported outcome measures (PROMs) were evaluated.
Results
Overall, 12 clinical and four preclinical studies met the inclusion criteria. Inconsistencies were found in defining the critical BBT across the clinical and preclinical data evaluated. The clinical evidence demonstrated that during healing, dimensional changes occur in the alveolar bone and in the BBW that may compromise the integrity of the peri‐implant bone, leading to VBL and mucosal recession (MR), particularly in scenarios exhibiting a thin BBW. The preclinical evidence validated the fact that implants placed in the presence of a thin BBW, are more prone to exhibit major dimensional changes and VBL. Moreover, the clinical data supported that, in scenarios where dehiscence‐type defects occur and are left for spontaneous healing, greater VBL and MR together with the occurrence of biologic complications are expected. Furthermore, the augmentation of dehiscence‐type defects is associated with hard and soft tissue stability. PROMs were not reported.
Conclusions
Dimensional changes occur as result of implant placement in healed ridges that may lead to instability of the peri‐implant hard and soft tissues. Sites presenting a thin BBW are more prone to exhibit major changes that may compromise the integrity of the buccal bone and may lead to biologic and esthetic complications.
... Generally, peri-implant mucositis, if left untreated, can progress to peri-implantitis. Peri-implant diseases can cause damage to the peri-implant soft and hard tissues and directly lead to implant failure [179]. ...
Dental implantation is currently the optimal solution for tooth loss. However, the health and stability of dental implants have emerged as global public health concerns. Dental implant placement, healing of the surgical site, osseointegration, stability of bone tissues, and prevention of peri-implant diseases are challenges faced in achieving the long-term health and stability of implants. These have been ongoing concerns in the field of oral implantation. Probiotics, as beneficial microorganisms, play a significant role in the body by inhibiting pathogens, promoting bone tissue homeostasis, and facilitating tissue regeneration, modulating immune-inflammatory levels. This review explores the potential of probiotics in addressing post-implantation challenges. We summarize the existing research regarding the importance of probiotics in managing dental implant health and advocate for further research into their potential applications.
... Implant failures due to biological complications or unsatisfactory esthetic outcomes very often originate from implant malpositioning or errors during implant surgery (Monje et al., 2016). Interestingly, peri-implantitis and esthetic failures are more commonly noted in the buccal aspects (Monje & Nart, 2022). Implants placed in healed sites must have an adequate buccal bone wall thickness (BBT) to ensure that the implant is circumferentially embedded in vital bone at the completion of bone healing. ...
Background: The significance on the association between the peri-implant bucco- lingual dimension (BLD) at the stage of implant placement and the occurrence of bio- logical and esthetic complications is yet unknown.
Material and methods: Systematic screening of electronic sources was carried out to identify clinical and preclinical studies reporting on the baseline BLD and/or buccal bone thickness (BBT) values. A secondary objective was to assess the effect of simul- taneous grafting at sites with deficient or no buccal bone wall (BBW) at baseline. The primary outcome variables were BBT, BLD, and buccal vertical bone loss (VBL) at re- evaluation. Moreover, radiographic, clinical, and patient-reported outcome measures (PROMs) were evaluated.
Results: Overall, 12 clinical and four preclinical studies met the inclusion criteria. Inconsistencies were found in defining the critical BBT across the clinical and preclini- cal data evaluated. The clinical evidence demonstrated that during healing, dimen- sional changes occur in the alveolar bone and in the BBW that may compromise the integrity of the peri-implant bone, leading to VBL and mucosal recession (MR), par- ticularly in scenarios exhibiting a thin BBW. The preclinical evidence validated the fact that implants placed in the presence of a thin BBW, are more prone to exhibit major dimensional changes and VBL. Moreover, the clinical data supported that, in scenarios where dehiscence-type defects occur and are left for spontaneous healing, greater VBL and MR together with the occurrence of biologic complications are expected. Furthermore, the augmentation of dehiscence-type defects is associated with hard and soft tissue stability. PROMs were not reported.
Conclusions: Dimensional changes occur as result of implant placement in healed ridges that may lead to instability of the peri-implant hard and soft tissues. Sites pre- senting a thin BBW are more prone to exhibit major changes that may compromise the integrity of the buccal bone and may lead to biologic and esthetic complications.
... 3,8,9 By contrast, when an implant fails, often considerable soft and hard tissue defects might occur after implant removal. 29,30 Three different methods were used in the presented cases to achieve an ovoid pontic rest, that were the intermediate pontic technique, 4 shaping the concave gingiva contact area with an electrotome sling, and the roll-flap technique. 18 Regardless of the technique used, the hard and soft tissue conditions around the pontics were stable 18 to 26 years after the RBFDPs were incorporated. ...
Objectives:
To present an update on the concept of cantilevered single-retainer all-ceramic resin-bonded fixed dental prostheses (RBFDPs) first presented 25 years ago in the Journal of Esthetic Dentistry.
Overview:
The initially presented case of the concept was followed clinically over 26 years and is presented along with two additional clinical long-term cases using varying methods to obtain an esthetic and hygienic ovate pontic design. Veneered alumina and zirconia ceramic (3 mol% yttria-tetragonal zirconia polycrystalline ceramic; 3Y-TZP) was used and bonded with a phosphate monomer containing luting resin after 50 μm alumina particle air-abrasion at 0.25 MPa pressure. The restorations replacing incisors did not debond and soft tissues in the pontic area were maintained over 26 years.
Conclusions:
Cantilevered single-retainer all-ceramic RBFDPs today made from veneered 3Y-TZP zirconia ceramic can be considered a standard of care for the replacement of single incisors and provide an excellent esthetic outcome with a long-term preservation of soft tissues in the pontic area.
Clinical significance:
Bonding nonretentive oxides ceramics such as alumina and zirconia ceramic with phosphate monomer containing luting resins after alumina particle air-abrasion is durable over decades. This proves that bonding to zirconia ceramic is not of any problem when adequate methods are used. Single-retainer zirconia ceramic RBFDPs maintain soft tissues in the edentulous area of single missing incisors and often deem implants unessential for this indication.
