29.Peri-implantitis reviewed in practice

Few large-scale follow-up studies are reported on routine implant treatment so this paper reported retrospective data on peri-implantitis and overall implant failures at one private referral clinic. A total of 1,017 patients were consecutively provided with 3,082 implants with an anodised surface during 1,592 operations between 2000 and 2011. All patients with any of four problems were identified; peri-implantitis, surgery related to peri-implantitis, overall implant failure and late implant failure. Lower jaw surgery and immediate gingival grafting at implant surgery were factors with the highest risk associated to the two peri-implantitis events, respectively. Overall, implant failures were associated with smoking, surgical technique (highest for direct placement) and type of implant (NobelActive CC). Implants lost after the first year only showed an association with lower jaw and early inflammation. Peri-implantitis seemed to be associated with surgical protocols more often in the posterior lower jaw in routine practice. The problems seem to increase during the inclusion period, possibly related to increased use of direct implant placement technique and grafting protocols. 

Jemt T et al. A retrospective study on 1592 consecutively performed operations in one private referral clinic. Part II: Peri-implantitis and implant failures. Clinical Implant Dent Related Res 2017 Feb 10. doi: 10.1111/cid.12477. [Epub ahead of print].

Q Overall implant failures were associated with which two risks?
A Lower jaw surgery and smoking
B Direct placement and type of implant
C Surgical technique and immediate gingival grafting
D Immediate gingival grafting and lower jaw surgery

30.Socket preservation 

This study compared the efficacy of immediate implant placement with alveolar bone augmentation following atraumatic tooth extraction and a tooth alveolar socket allowed to heal conventionally. Twenty patients needing non-complicated extraction of mandibular premolar teeth were divided randomly and equally into two groups: the empty extraction socket was left untreated and allowed to heal in a conventional way; the immediate implant was placed and the gap between the implant and the inner buccal plate surface of the socket wall was filled with lyophilised bovine bone granules and the wound was covered with pericardium membrane. The patients were followed up clinically and radiologically for regular reviews at 1 week, 3 months, and 9 months postoperative. The insertion of immediate implants in fresh extraction sockets together with grafting the circumferential gap between the bony socket wall and the implant surface with bovine bone granules was able to preserve a greater amount of alveolar ridge volume when compared with an extraction socket that was left to heal in a conventional way.

Qabbani AA et al. The efficacy of immediate implant placement in extraction sockets for alveolar bone preservation. J Craniofacial Surg 2017 Feb 22 doi: 10.1097/SCS.03569. [Epub ahead of print].

Q To give a greater chance of immediate placement implant success would you? 
A Extract an additional tooth next to the implant site to allow bone infill
B Graft the socket with pericardium membrane
C Allow a socket to heal in a conventional way
D Graft the bony socket wall and the implant surface with bovine bone granules

31.Loaded questions

Patients with a missing maxillary tooth (teeth 15-25) were randomly assigned to compare the overall treatment outcome following immediate loading (IL) and delayed loading (DL) of single implants after 1 year of follow-up. The protocol included implant installation in healed sites, immediate loading, delayed loading, temporary screw-retained restoration, and replacement with a permanent single implant crown. Outcome measures were implant survival, marginal bone level, soft tissue changes, papillae index, pink, and white aesthetic score (PES and WES), patient judged aesthetics, and oral health impact profile (OHIP-14).
Implant survival rate was 100% and 96% for IL and DL, respectively. Implant success rate was 96% and 88% for IL and DL, respectively. Statistically significant lower papilla index scores were found in the IL group at temporary crown and definitive crown placement. An overall statistically significant improvement after 12 months for PES, WES and OHIP-14 was found. This prospective randomised study showed that single implants in the maxilla can present satisfactory results with respect to either immediate loading or delayed loading after 12 months.

Gjelvold B et al. Clinical and radiographic outcome following immediate loading and delayed loading of single-tooth implants: Randomized clinical trial. Clinical Implant Dent Related Res 2017 Feb 19. doi: 10.1111/cid.12479. [Epub ahead of print].

Q Single tooth implants in the maxilla:
A Have a higher percentage success rate with delayed loading
B Are satisfactory with either immediate loading or delayed loading after 12 months
C Have a lower survival rate with immediate loading
D Are best applied to the mandible instead

32.Indications for successful placement 

The aim of this study was to review the indications for implant placement, early outcomes, and associated risk factors using a group of 509 consecutive patients, which represented the total number of patients treated from 2012 to 2014 in a hospital department. The authors analysed the indications for implant placement and the potential risk factors for early implant failure. The patients received 1,139 dental implants, the most frequent indication for implant placement was restoration of a partially edentulous arch (80.1%, n = 408). For 152 implants (13.3%), additional bone-augmentation or sinus elevation procedures were required. Early failures were recorded for 52 (4.6%) implants in 33 patients (6.5%). Smoking, male gender, total edentulism, implant diameter, and bone augmentation surgery were found to be associated with early implant failure. Patients referred for implant placement were more likely to be partially edentulous and older than 50 years. Single tooth replacement in the posterior mandible was the most frequent indication (24.4%) for treatment. 

Grisar K et al. Retrospective analysis of dental implants placed between 2012 and 2014: indications, risk factors, and early survival. Int J Oral Maxillofacial Implants 2017 Feb 17 doi: 10.11607/jomi.5332. [Epub ahead of print].

Q What category of patient would be more likely to experience early implant failure?
A An edentulous female non-smoker 
B A dentate female smoker
C An edentulous male smoker 
D A dentate male non-smoker