Journal of Dental Implants
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   Table of Contents - Current issue
Coverpage
July-December 2021
Volume 11 | Issue 2
Page Nos. 65-113

Online since Tuesday, December 14, 2021

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EDITORIAL  

Bone loss around implants: Is it inevitable, preventable, irreversible, or untreatable? p. 65
Sharat Shetty
DOI:10.4103/jdi.jdi_32_21  
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REVIEW ARTICLE Top

Clinical decision-making in diagnosis and treatment of peri-implant diseases and conditions with 2017 Classification System p. 68
Deepak Sharma
DOI:10.4103/jdi.jdi_16_21  
As the practice of dental implantology keeps growing exponentially worldwide, implantologists face an ever-increasing challenge to manage peri-implant diseases and complications. At present, the approaches to diagnose, classify, and treat peri-implant diseases are not uniform, standardized, or systematic. To address these limitations, a classification for peri-implant diseases and conditions was presented in the Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions in 2017 organized by the American Academy of Periodontology and European Federation of Periodontology. Since its inception in 2017, this comprehensive classification system has become the new standard of clinical practice around the world. The article provides an overview and description of peri-implant diseases, their classification criteria, diagnostic techniques, and management approaches based on the 2017 Classification System. The flowcharts and decision trees presented can guide implantologists on how to deal with implant complications, in particular peri-implant diseases, including peri-implant mucositis, peri-implantitis, and implant soft- and hard-tissue deficiencies. Future long-term studies in this area are definitely needed to establish the effectiveness of various treatment approaches.
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ORIGINAL ARTICLES Top

Resistance to dynamic and static loading of the implant mounts on its respective implant p. 78
Daniela Blanco-Gonzalez, Francisco Villalobos-Ramirez, Otton Fernandez-Lopez, Daniel Chavarria-Bolanos, Tatiana Vargas-Koudriavtsev
DOI:10.4103/jdi.jdi_4_21  
Introduction: Implant restorations should endure a variable range of forces over a long period of time. Some commercial brands offer the implant together with an accessory called “implant mount” or “implant holder,” which might be used as a temporary abutment. However, scientific literature in the use of implant holders as abutments for restorations is scarce. Objectives: The purpose of this in vitro study was to compare the load at which implant holders of Implant Direct® and Zimmer® fail under static compression after being subjected to fatigue, and to compare the gap produced between the implant–holder complexes after dynamic loading. Materials and Methods: The test protocol was based on the recommendation of ISO 14801. Five implant–implant holder assemblies of each brand were subjected to dynamic loading. A load of 250 N was applied at 5 × 106 cycles and at 15 Hz stress frequency (Eden Prairie, MN, USA). The gap (μm) at the interface was measured postfatigue using scanning electron microscopy (S-3700N, HITACHI, Japan), and afterward, static loading was applied and the maximum load (N) after the point of failure was established. Implant–definitive abutment complexes were used as controls. Data were analyzed by means of a central tendency measurement test Mann–Whitney U-test (nonparametric). Results: There was no difference between both the implant holder groups (P ≤ 0.05); however, a slight trend of greater resistance was observed for the Zimmer® group. The gap in the interface was greater for Implant Direct® implants, but the difference was not statistically significant. Conclusion: No significant differences were found in terms of the maximum load under compression or the interface gap after the dynamic loading in the two experimental groups.
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Radiographic assessment of alveolar bone loss around customized root analog zirconia implants placed in fresh extraction sockets p. 84
Amod Patankar, Rajesh Kshirsagar, Swapna Patankar, Rakhi S Purkayastha, Sudhir Pawar, Krishnanunni Nair
DOI:10.4103/jdi.jdi_13_21  
Aim: The aim of this study is to evaluate the radiographic assessment of alveolar bone loss around customized root analog zirconia implants placed in fresh extraction sockets using the cone-beam computed tomography at predetermined intervals. Subjects and Methods: The present study comprised twenty individuals all above 18 years with at least one tooth indicated for extraction. The twenty participants were considered in a single group who underwent single tooth extraction followed by the placement of root analog zirconia implant after 7 days which was fabricated using computer-aided design and computer-aided manufacturing technology. The participants were evaluated radiographically using Cone-Beam Computed Tomography (CBCT) at predetermined intervals: • Within 48 h of implant placement (CBCT I) • At the time of composite crown cementation on zirconia implant after 4 months of placement (CBCT II) • After 4 months of composite crown cementation (CBCT III). The alveolar bone loss was measured on all the four surfaces of the implant. CBCT was used only for the required area so to avoid total radiation exposure to the patient. Statistical Analysis Used: The survival of dental implants was computed using the Kaplan–Meier method. The comparison of the mesial, distal, buccal, and lingual bone height at 3 different time intervals was analyzed using the repeated-measures analysis of variance. Results: Radiographic assessment of alveolar bone loss around customized root analog zirconia implants placed in fresh extraction sockets in predetermined time interval using the cone-beam computed tomography (CBCT) was taken to be statistically significant (P ≤ 0.05). Conclusions: An innovative technique for immediate replacement of extracted tooth using customized Zirconia root analog implant was introduced. In future, long-term evaluation with more sample size is necessary to assess the success and survival of implant placed using this technique.
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Hybrid implants in the dental rehabilitation of posterior maxilla: A prospective clinical evaluation p. 89
Rajkumar Krishnaprabhu, R Arunkumar Shadamarshan, Sanjay Kumar Roy Chowdhury
DOI:10.4103/jdi.jdi_17_21  
Context: Implant-retained prosthodontic rehabilitation of the posterior maxilla poses a unique challenge due to deficiency in bony characteristics in many cases, thereby requiring elaborate adjunctive surgical procedures to aid in implant placement. Aims: We aimed to evaluate the efficacy of hybrid implants in the prosthodontic rehabilitation of edentulous posterior maxilla. Subjects and Methods: Prospective clinical evaluation of 27 patients (30 implants) rehabilitated using hybrid implants at 1 and 4 weeks after implant placement and 3, 6, and 12 months after functional loading was conducted. Statistical Analysis Used: Descriptive statistics were used for statistical analysis. Results: The average pain score on the Visual Analog Scale was 4.53 and 0.76 at the end of 1st week and 4 weeks. Four implants (13.33%) were found unstable by 4 weeks. Two implants (6.67%) had exposure by 12 months. Less than 1 mm of mobility was seen in one implant (3.33%) by 3 months, four implants (13.33%) by 6 months, and five implants (16.67%) by 12 months. One implant (3.33%) developed mobility up to 2 mm by 12 months. Seven implants (23.33%) showed a probing depth of ≥5 mm but none more than 6 mm. Gingival recession of 2 and 3 mm was seen in two implants (6.67%) and one implant (3.33%), respectively, at the end of 12 months. The average bone loss was 0.17, 0.31, and 0.46 mm by 3, 6, and 12 months. The average rate of bone loss was 0.02 mm per month. Conclusions: Hybrid implant is an excellent alternative in patients with inadequate bone in the posterior maxilla precluding the requirement of maxillary sinus lift and grafting.
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Hybrid implants in the dental rehabilitation of posterior maxilla: A prospective clinical evaluation p. 89
Rajkumar Krishnaprabhu, R Arunkumar Shadamarshan, Sanjay Kumar Roy Chowdhury
DOI:10.4103/jdi.jdi_17_21  
Context: Implant-retained prosthodontic rehabilitation of the posterior maxilla poses a unique challenge due to deficiency in bony characteristics in many cases, thereby requiring elaborate adjunctive surgical procedures to aid in implant placement. Aims: We aimed to evaluate the efficacy of hybrid implants in the prosthodontic rehabilitation of edentulous posterior maxilla. Subjects and Methods: Prospective clinical evaluation of 27 patients (30 implants) rehabilitated using hybrid implants at 1 and 4 weeks after implant placement and 3, 6, and 12 months after functional loading was conducted. Statistical Analysis Used: Descriptive statistics were used for statistical analysis. Results: The average pain score on the Visual Analog Scale was 4.53 and 0.76 at the end of 1st week and 4 weeks. Four implants (13.33%) were found unstable by 4 weeks. Two implants (6.67%) had exposure by 12 months. Less than 1 mm of mobility was seen in one implant (3.33%) by 3 months, four implants (13.33%) by 6 months, and five implants (16.67%) by 12 months. One implant (3.33%) developed mobility up to 2 mm by 12 months. Seven implants (23.33%) showed a probing depth of ≥5 mm but none more than 6 mm. Gingival recession of 2 and 3 mm was seen in two implants (6.67%) and one implant (3.33%), respectively, at the end of 12 months. The average bone loss was 0.17, 0.31, and 0.46 mm by 3, 6, and 12 months. The average rate of bone loss was 0.02 mm per month. Conclusions: Hybrid implant is an excellent alternative in patients with inadequate bone in the posterior maxilla precluding the requirement of maxillary sinus lift and grafting.
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CASE REPORTS Top

Successful management of advanced peri-implantitis with guided bone regeneration: A case report with a 2-year follow-up p. 97
Gulnar Dara Sethna, Rajesh Prabhakar Gaikwad, Rajat Nahar, Satish Sudhakar Gadai, Noopur Subhash Narayane
DOI:10.4103/jdi.jdi_12_21  
Dental implants play a pivotal role in the rehabilitation of missing teeth and have been revolutionary in the field of dentistry. However, clinical and biological complications may be associated with dental implants and may occur primarily due to bacterial infection in the soft and hard tissue around the implants. These are known as peri-implant mucositis and peri-implantitis. Management of peri-implant and peri-apical infections, so as to achieve re-osseointegration of the exposed implant surfaces, is often challenging for the treating dentist. Various treatment modalities of peri-implant diseases include nonsurgical and surgical therapy. This case report describes successful management and a 2-year follow-up of a case of advanced peri-implantitis using a protocol that involves thorough debridement, decontamination, and guided bone regeneration.
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Management of long-standing edentulous space with dental implants: An interdisciplinary approach p. 104
Ashwini Naidu, Monish Shashikumar Naidu
DOI:10.4103/jdi.jdi_8_21  
Long-standing edentulous cases due to missing permanent mandibular first molars commonly result in mesial tipping and migration of second molars in the edentulous space. In order to place an optimum-sized dental implant and crown for replacement of the missing tooth space regaining by uprighting and distalization of the second molar is essential. Various orthodontic techniques using fully bonded fixed appliances and segmental orthodontics with coil springs, loops, and miniscrew orthodontic implants have been used for space regaining. Obtaining three-dimensional control during tooth movement in segmental orthodontics is challenging as all the forces are applied to the teeth buccally. This case report shows a method to regain space using a long head miniscrew orthodontic implant placed at the retromolar pad area with three-dimensional control during second molar uprighting and distalization followed by restoration with a dental implant.
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Thick soft tissues around implant-supported restoration; stable crestal bone levels? p. 109
Farhan Durrani, Samidha Pandey, Rakhshinda Nahid, Preeti Singh, Aishwarya Pandey
DOI:10.4103/jdi.jdi_29_20  
The peri-implant tissue remodeling just after implant surgery forms a coagulum that occupies the space between mucosa and implant. This is invaded by neutrophils and a barrier forms around implant consisting of dense fibrin network. In another 2 weeks post surgery, it is replaced by connective tissue and vascular structures. In the crestal area, the proliferation of epithelium takes place and forms a junctional epithelium. The barrier epithelium around the implant matures in 6–8 weeks. Formation of biological width begins when the implant gets exposed to the oral environment. This could be through healing screw or prosthetic abutment depending on connection to the implant. It is said that thin or thick tissues have different approaches to healing as the blood supply is varied. Flap is raised during the second stage of implant surgery damaging the blood supply of surrounding tissues. Thin mucosa present around the implant crestal area might lead to more bone loss but not thick tissues as more blood vessels are present here. Bone turnover can lead to crestal bone loss up to 3.2 mm apical to soft-tissue margin. The thickness of the tissues may be a recognized biological factor that might lead to crestal bone stability. In this report, we describe three cases where bone remodeling was camouflaged by thick soft tissues around implant-supported restorations.
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