Search

This study investigated the effect of initial nonsurgical treatment in patients with peri-implantitis with or without prescription of an antibiotic regimen consisting of amoxicillin and metronidazole. For this purpose, patients with peri-implantitis were randomized into a group of initial treatment with antibiotics and a group without antibiotics. They were re-evaluated 12 weeks after treatment. Analyses were performed at the patient level at 1 peri-implant pocket per patient. Both groups showed significant peri-implant pocket depth reductions after initial treatment. Treatment with antibiotics resulted in a higher mean reduction in peri-implant pocket depth than when no antibiotics were used, but this difference did not reach statistical significance. Only 2 implants, 1 in each group, showed a successful outcome of a peri-implant pocket depth ofunder ≤ 5 mm and with an absence of bleeding and pus after probing. Initial treatment with or without antibiotics is ultimately not sufficient to fully treat peri-implantitis; additional surgical procedures will often be required.

Objectives: To assess the adjunctive effect of systemic amoxicillin (AMX) and metronidazole (MTZ) in patients receiving non-surgical treatment (NST) for peri-implantitis (PI)., Materials and Methods: Thirty-seven patients were randomized into an experimental group treated with NST plus AMX + MTZ (N = 18) and a control group treated with NST alone (N = 19). Clinical parameters were evaluated at 12 weeks post-treatment. The primary outcome was the change in peri-implant pocket depth (PIPD) from baseline to 12 weeks, while secondary outcomes included bleeding on probing (BoP), suppuration on probing (SoP), and plaque. Data analysis was performed at patient level (one target site per patient)., Results: All 37 patients completed the study. Both groups showed a significant PIPD reduction after NST. The antibiotics group showed a higher mean reduction in PIPD at 12 weeks, compared with the control group (2.28 ± 1.49 mm vs. 1.47 ± 1.95 mm), however, this difference did not reach statistical significance. There was no significant effect of various potential confounders on PIPD reduction. Neither treatment resulted in significant improvements in BoP at follow-up; 30 of 37 (81%) target sites still had BoP after treatment. Only two implants, one in each group, exhibited a successful outcome defined as PIPD < 5 mm, and absence of BoP and SoP., Conclusions: Non-surgical treatment was able to reduce PIPD at implants with PI. The adjunctive use of systemic AMX and MTZ did not show statistically significant better results compared to NST alone. NST with or without antibiotics was ineffective to completely resolve inflammation around dental implants., (© 2022 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Objectives: To investigate whether xenograft EB (EndoBon) is non-inferior to xenograft BO (Bio-Oss) when used in reconstructive surgery of peri-implant osseous defects., Materials and Methods: Dental patients with one implant each demonstrating peri-implantitis were randomized to receive surgical debridement and defect fill with either BO or EB. Changes in bone level (BL) and intrabony defect depth (IDD) evaluated radiographically were the primary outcomes. The secondary outcomes included changes in probing pocket depth (PPD), bleeding on probing (BoP), and suppuration on probing (SoP). All outcomes were recorded before treatment and at 6 and 12 months post-treatment., Results: Twenty-four patients (n = 11 BO, n = 13 EB) completed the study. Both groups demonstrated significant within-group improvements in all clinical and radiographic parameters at 6 and 12 months (p ≤ .001). At 12 months, both groups presented with IDD reductions of 2.5-3.0 mm on average. The inter-group differences were not statistically significant at all time points and for all the examined parameters (p > .05). While the radiographic defect fill in both groups exceeded > 1 mm and can be considered treatment success, successful treatment outcomes as defined by Consensus Reporting (no further bone loss, PPD ≤ 5 mm, no BOP, and no SoP) were identified in 2/11 (18%) BO and 0/13 (0%) EB individuals (Fisher's exact test, p = .199)., Conclusions: Within the limitations of this pilot study, the application of xenograft EB showed to be non-inferior to xenograft BO when used in reconstructive surgery of peri-implant osseous defects., (© 2020 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Purpose: Three-dimensional (3D) autotransplantation is a technique for surgical transposition of a tooth to another site within one patient, using 3D printed replicas of the donor tooth. In this study, we evaluated intraoperative experiences during 3D autotransplantation of teeth., Materials and Methods: A multicenter prospective clinical study was implemented. All procedures were performed using preoperative cone-beam computed tomography imaging and computer-assisted design with computer-assisted manufacturing resulting in a 3D replica of the donor tooth., Results: The 100 autotransplantation procedures (79 patients) included canines, premolars, molars, and 1 supernumerary tooth. In 82% of the procedures, the transplantation was performed with an extra-alveolar time of less than 1 minute and an immediate good fit of the donor tooth. In 14%, the extra-alveolar time was 1 to 3 minutes or multiple fitting attempts were necessary. In 4%, the extra-alveolar time exceeded 3 minutes. Difficulties during the procedures were caused by movement artifacts on the preoperative cone-beam computed tomography imaging, a long interval between the imaging and the procedure, or insufficient bone volume at the recipient site., Conclusions: The use of a 3D printed donor tooth replica during autotransplantation procedures minimized the extra-alveolar time and intraoperative fitting attempts of transplants. This facilitated a quick and reliable treatment and enabled more difficult procedures., (Copyright © 2019 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Seriously damaged molars can be replaced by autotransplantation with the help of 3D techniques. In the present case, involving an 18-year old patient, 18, 38 and 48 were used to replace, respectively, 14, 36 and 37. Preoperatively, the width of the crowns and the root development of 18, 38 and 48 were analysed using 3D imaging. During the autotransplantation procedure, the new alveoli are formed with the help of replicas of the donor molars printed in 3D, in order to prevent iatrogenic damage to the actual donor molars.. The extra-alveolar time was less than 2 minutes for all donor molars. Postoperative follow-up showed physiologic integration of the transplanted molars. There was no ankylosis. Autotransplantation with the help of 3D techniques makes it possible to perform complex procedures with good results.

This systematic review provides an overview of studies on autotransplantation techniques using rapid prototyping for preoperative fabrication of donor tooth replicas for preparation of the neo-alveolus. Different three-dimensional autotransplantation techniques and their treatment outcomes are discussed. The systematic literature search yielded 19 articles that satisfied the criteria for inclusion. These papers described one case-control study, four clinical observational studies, one study with a clinical and in vitro part, four in vitro studies, and nine case reports. The in vitro studies reported high accuracy for the printing and planning processes. The case reports all reported successful transplantation without any pathological signs. The clinical studies reported a short extraoral time of the donor tooth, with subsequent success and survival rates of 80.0-91.1% and 95.5-100%, respectively. The case-control study reported a significant decrease in extraoral time and high success rates with the use of donor tooth replicas. In conclusion, the use of a preoperatively designed surgical guide for autotransplantation enables accurate positional planning, increases the ease of surgery, and decreases the extraoral time. However, the quality of the existing body of evidence is low. Further research is therefore required to investigate the clinical advantages of this innovative autotransplantation technique., (Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

This article describes the autotransplantation of third molars to replace heavily damaged premolars and molars. Specifically, this article reports on the use of preoperative cone-beam computed tomographic planning and 3-dimensional (3D) printed replicas of donor teeth to prepare artificial tooth sockets. In the present case, an 18-year-old patient underwent autotransplantation of 3 third molars to replace 1 premolar and 2 molars that were heavily damaged after trauma. Approximately 1 year after the traumatic incident, autotransplantation with the help of 3D planning and rapid prototyping was performed. The right maxillary third molar replaced the right maxillary first premolar. The 2 mandibular wisdom teeth replaced the left mandibular first and second molars. During the surgical procedure, artificial tooth sockets were prepared with the help of 3D printed donor tooth copies to prevent iatrogenic damage to the actual donor teeth. These replicas of the donor teeth were designed based on the preoperative cone-beam computed tomogram and manufactured with the help of 3D printing techniques. The use of a replica of the donor tooth resulted in a predictable and straightforward procedure, with extra-alveolar times shorter than 2 minutes for all transplantations. The transplanted teeth were placed in infraocclusion and fixed with a suture splint. Postoperative follow-up showed physiologic integration of the transplanted teeth and a successful outcome for all transplants. In conclusion, this technique facilitates a straightforward and predictable procedure for autotransplantation of third molars. The use of printed analogues of the donor teeth decreases the risk of iatrogenic damage and the extra-alveolar time of the transplanted tooth is minimized. This facilitates a successful outcome., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to explore the feasibility of fabrication of three-dimensional (3D)-printed zirconia root analogue implant (RAI) through digital light processing (DLP) technology., Material and Methods: One partially edentulous mandibular human cadaver was scanned with a cone-beam computed tomography (CBCT) system. The scan volumes and data sets were used to create computer-aided design (CAD) model of the RAI. A high-end DLP 3D printing technology was used to fabricate the RAI from the CAD model. Within this approach, solid 3D objects are built using a DLP projector to translate voxel data so it is reproduced in liquid photopolymer dispersed with a commercial ceramic, thereby light polymerizing the resin to solid. Optical scanning technology was used to measure the tooth and 3D-printed RAI. To validate the accuracy of the printed zirconia RAI, the optical surface model of the original tooth and CAD model were superimposed., Results: The differences between the optical scans of the RAI and original tooth are most noticeable towards the apical foramen, showing a disparity for the RAI with a maximum deviation of 0.86 mm. When setting a maximum threshold of 0.5 mm for the 3D-printed RAI surface to be deviating from the original tooth model and CAD model, measurements show 1.55% and 4.86% of the surface areas are exceeding the threshold distance, respectively., Conclusion: With the use of currently available technology, it is well feasible to 3D print in zirconia a custom RAI., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: The aim of the present cadaveric study was to assess the accuracy of computer-assisted template-guided autotransplantation of teeth with custom 3-dimensional (3D) designed/printed surgical tooling., Materials and Methods: Ten partially edentulous human mandibular cadavers were scanned using a cone-beam computed tomography (CBCT) system and an intraoral scanning system. The 3D data of these cadavers were imported to specialized software and used to analyze the region of the recipient sites, and the donor teeth were selected. Subsequently, congruent to the donor teeth, custom surgical tooling and surgical-guided templates were designed and 3D printed. The guided osteotomies were performed and the donor teeth transplanted. To evaluate the planned donor teeth positions compared with the transplanted donor teeth positions, the mandibles were scanned again using the CBCT system, and software matching was applied to measure the accuracy of the procedure., Results: The mean angular deflection of the transplanted donor teeth with the planned donor teeth positions was 5.6 ± 5.4°. Comparing the 3D positions of the shoulders, a mean deviation of 3.15 ± 1.16 mm and a mean apical deviation of 2.61 ± 0.78 mm were found., Conclusions: The described method of computer-assisted template-guided autotransplantation of teeth with custom 3D designed/printed surgical tooling could potentially provide a relatively accurate alternative for the currently available treatment approaches. Further research should focus on improving the accuracy of this technique and evaluating the clinical success and advantages of this method., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to introduce a new concept for computer-assisted template-guided placement of a custom 3D-designed/3D-printed implant with congruent custom 3D-designed/3D-printed surgical tooling and to test the feasibility and accuracy of this method in-vitro., Materials and Methods: One partially edentulous human mandibular cadaver was scanned with a cone-beam computed tomography (CBCT) system and intra-oral scan system. The 3D data of this cadaver were imported in specialized software and used to analyse the region of a missing tooth. Based on the functional and anatomical parameters, an individual implant with congruent surgical tooling and surgical guided template was designed and 3D-printed. The guided osteotomy was performed, and the custom implant inserted. To evaluate the planned implant position in comparison with the placed implant position, the mandible with implant was scanned again with the CBCT system and software matching was applied to measure the accuracy of the procedure., Results: The angular deflection with the planned implant position was 0.40°. When comparing the 3D positions of the shoulder, there is a deviation of 0.72 mm resulting in an apical deviation of 0.72 mm., Conclusion: With the use of currently available technology, it is very well feasible to create in a virtual simulation a custom implant with congruent custom surgical tooling and to transfer this to a clinical setting. However, further research on multiple levels is needed to explore this novel approach., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Autotransplantation is a valuable technique offering a physiological type of tooth replacement to patients with missing teeth. Teeth with open apices (50-75% apical closure) will regenerate with vitality following autotransplantation. The success rate following an autotransplantation is 82%. The remaining 18% can usually still be treated successfully with a simple additional treatment. The tooth survival rate 10 years after autotransplantation is higher than 90%. The use of 3D techniques makes it possible to create a pre-operative replica of the donor tooth. With this, a new alveolus can be prepared at the transplant site even before extraction. This technique reduces the extra-alveolar time for the donor tooth and minimises the possibility of iatrogenic damage. This results in a streamlined procedure, enabling better planning with better results.

Purpose: The aim of this study was to introduce a novel method for accurate autotransplantation with computer-assisted guided templates and assembled custom-designed surgical tooling and to test the feasibility and accuracy of this method ex vivo., Materials and Methods: A partially edentulous human mandibular cadaver was scanned with a cone-beam computed tomography (CBCT) system and an intraoral scan system. The 3-dimensional (3D) data of this cadaver were imported into specialized software and used to analyze the region of the recipient site and the donor tooth was selected. Subsequently, congruent to the donor tooth, custom surgical tools and a surgical guided template were designed and 3D printed. The guided osteotomy was performed and the donor tooth was transplanted. To evaluate the planned position of the donor tooth in relation to the position of the transplanted donor tooth, the mandible with the transplanted donor tooth was rescanned with the CBCT system and software matching was applied to measure the accuracy of the procedure., Results: The angular deflection of the transplanted donor tooth in relation to the planned donor tooth position was 3.1°. When comparing the 3D positions of the shoulder, there was a deviation of 1.25 mm and an apical deviation of 0.89 mm., Conclusion: With the use of currently available technology, it is feasible to accurately plan and create in a virtual simulation a donor tooth position with congruent custom surgical tools and to transfer this to a clinical setting with 3D printing. However, further research on multiple levels is needed to explore this novel approach., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives. The aim of this study was to analyse by means of FEA the influence of 5 custom RAI designs on stress distribution of peri-implant bone and to evaluate the impact on microdisplacement for a specific patient case. Materials and Methods. A 3D surface model of a RAI for the upper right canine was constructed from the cone beam computed tomography data of one patient. Subsequently, five (targeted) press-fit design modification FE models with five congruent bone models were designed: "Standard," "Prism," "Fins," "Plug," and "Bulbs," respectively. Preprocessor software was applied to mesh the models. Two loads were applied: an oblique force (300 N) and a vertical force (150 N). Analysis was performed to evaluate stress distributions and deformed contact separation at the peri-implant region. Results. The lowest von Mises stress levels were numerically observed for the Plug design. The lowest levels of contact separation were measured in the Fins model followed by the Bulbs design. Conclusions. Within the limitations of the applied methodology, adding targeted press-fit geometry to the RAI standard design will have a positive effect on stress distribution, lower concentration of bone stress, and will provide a better primary stability for this patient specific case.

There is a paucity of data for the effectiveness of reconstructive procedures in the treatment of peri-implantitis. The objective of this study was to compare reconstruction of peri-implant osseous defects with open flap debridement (OFD) plus porous titanium granules (PTGs) compared with OFD alone. Sixty-three patients (36 female, 27 male; mean age 58.4 y [SD 12.3]), contributing one circumferential peri-implant intraosseous defect, were included in a multinational, multicenter randomized trial using a parallel-group design. After OFD and surface decontamination using titanium brushes and hydrogen peroxide, 33 defects received PTGs. The implants were not submerged. All patients received adjunctive perioperative systemic antibiotics. The primary outcome variable (defect fill) was assessed on digitalized radiographs. Clinical measurements of probing depth (PPD), bleeding on probing (BoP), suppuration, and plaque were taken by blinded examiners. After 12 mo, the test group (OFD plus PTG) showed a mean radiographic defect fill (mesial/distal) of 3.6/3.6 mm compared with 1.1/1.0 in the control group (OFD). Differences were statistically significant in favor of the test group (P < 0.0001). The OFD plus PTG group showed a mean reduction in PPD of 2.8 mm compared with 2.6 mm in the OFD group. BoP was reduced from 89.4% to 33.3% and from 85.8% to 40.4% for the test and control groups, respectively. There was no significant difference in complete resolution of peri-implantitis (PPD ≤4 mm and no BoP at six implant sites and no further bone loss), because this finding was accomplished at 30% of implants in the test group and 23% of implants in the control group. Reconstructive surgery using PTGs resulted in significantly enhanced radiographic defect fill compared with OFD. However, limitations in the lack of ability to discern biomaterial from osseous tissue could not be verified to determine new bone formation. Similar improvements according to clinical measures were obtained after both surgical treatment modalities (ClinicalTrials.gov NCT02406001)., (© International & American Associations for Dental Research 2015.)

Background and Objective: To assess inflammatory reactions of fibroblasts in the pathophysiology of peri-implantitis, we compared the pro-inflammatory and matrix-degrading responses of gingival and granulation tissue fibroblasts from periodontally healthy controls, peri-implantitis, and periodontitis lesions to an in vitro challenge with Porphyromonas gingivalis., Methods: Fibroblasts from periodontally healthy, peri-implantitis and periodontitis donors were challenged with viable P. gingivalis. The inflammatory reactions of fibroblasts were analyzed before and after 6 h P. gingivalis challenge, and 2.5 and 18 h after removal of the challenge. Gene expression and induction of pro-inflammatory mediators, and matrix metalloproteinases (MMPs) were assessed by real-time polymerase chain reaction. Protein expression was measured by enzyme-linked immunosorbent assay., Results: Non-challenged fibroblasts from peri-implantitis and periodontitis lesions expressed higher levels of interleukin (IL)-1β, IL-8, and monocyte chemotactic protein (MCP)-1 than fibroblasts from periodontally healthy individuals. The P. gingivalis challenge induced expression of IL-1β, IL-8, IL-6, MCP-1, and MMP-1 in periodontitis and peri-implantitis fibroblasts, but not in fibroblasts from periodontally healthy individuals. MMP-8 expression was higher in non-challenged peri-implantitis fibroblasts than in fibroblasts from periodontally healthy individuals. However, the P. gingivalis challenge downregulated MMP-8 gene expression in peri-implantitis fibroblasts. After removal of the P. gingivalis challenge, peri-implantitis fibroblasts sustained higher induction of IL-1β, MCP-1, and MMP-1 compared to periodontitis fibroblasts., Conclusions: Fibroblasts from peri-implantitis and periodontitis lesions gave a more pronounced inflammatory response to the P. gingivalis challenge than fibroblasts from healthy donors. They may therefore be involved in the development of inflammation in peri-implantitis and periodontitis. Moreover, the sustained upregulation of inflammatory mediators and MMP-1 in peri-implantitis fibroblasts may play a role in the pathogenesis of peri-implantitis., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background and Objective: The aim of the study was to compare the detection of Porphyromonas gingivalis using a fluorescence resonance energy transfer (FRET) technology with commonly used diagnostic methods in salivary and subgingival plaque samples from subjects with dental implants. P. gingivalis was considered as a marker for a pathogenic microbiota., Material and Methods: Ninety-seven adult subjects were recruited, including periodontally healthy controls with no dental implants, implant controls with no peri-implant disease and patients with peri-implant disease. Saliva and subgingival/submucosal plaque samples were collected from all subjects and were analyzed using culture, real-time PCR and FRET technology employing P. gingivalis-specific substrates., Results: It was found that the P. gingivalis-specific substrates were highly suitable for detecting the presence of P. gingivalis in saliva and in subgingival plaque samples, showing comparable specificity to culture and real-time PCR., Conclusion: We applied the FRET technology to detect P. gingivalis in implant patients with or without an implant condition and in controls without implants. The technique seems suitable for detection of P. gingivalis in both plaque and saliva samples. However, with all three techniques, P. gingivalis was not very specific for peri-implantitis cases. Future work includes fine-tuning the FRET technology and also includes the development of a chair-side application., (© 2012 John Wiley & Sons A/S.)