Journal of Dental Implants
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   Table of Contents - Current issue
Coverpage
January-June 2022
Volume 12 | Issue 1
Page Nos. 1-75

Online since Thursday, June 16, 2022

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EDITORIAL  

Inclined controversy: Angled implants and abutments p. 1
Sharat Shetty
DOI:10.4103/jdi.jdi_12_22  
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REVIEW ARTICLES Top

Co-relation of Vitamin D and senile osteoporosis in relation to dental implant p. 4
Rosy Raheja
DOI:10.4103/jdi.jdi_18_21  
In the past few years, the prosthodontic educational and research focus evolved beyond traditional therapeutic approaches. This progress resulted from three major initiatives. First, materials research has simplified impression-making protocol and denture relining technique. Second, improved understanding of the role and particularly the limitations of mechanical analogs for the masticatory system (i.e., articulators). The third initiative, and the major research and educational catalyst, has been the technique of osseointegration, which has had a profound impact on research and education in virtually all our clinical endeavors. As a result, the consequences of an aging edentulous environment or a terminal dentition have been more successfully addressed than ever before and many clinicians even began to forecast the demise of the complete denture technique. Thankfully though, the initial euphoria resulting from the availability of implant-supported solutions has now ablated, and a more realistic assessment has emerged. In this article, emphasis more on correlation of senile osteoporosis and role of Vitamin D in relation to the success of oral implantology.
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Systemic medications and implant success: Is there a link? part one: The effects of antihypertensives, oral hypoglycaemic agents and insulin on the outcome of implant therapy p. 10
Prema Sukumaran, Dionetta Delitta Dionysius, Wei Cheong Ngeow, Chuey Chuan Tan, Mohd Zamri Hussin
DOI:10.4103/jdi.jdi_22_21  
Dental implants require healthy bone for successful osseointegration. However, bone health can become compromised by ageing and/or the presence of underlying medical conditions. The severity and complications associated with these medical conditions usually indicate that they require medication for successful management. Some of these medications may undoubtedly exert effects on bone through direct or indirect mechanisms and therefore, may also affect osseointegration. These include antihypertensives, oral hypoglycaemic agents (OHAs)/insulin, hormones (corticosteroid, thyroxin and tamoxifen) and anti-resorptive agents including bisphosphonates and anti-angiogenic agents. Part One of this paper reviews the current knowledge regarding the effects of antihypertensives, OHAs and insulin on the outcome of implant therapy.
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Systemic medications and implant success: Is there a link? Part two: The effects of therapeutic hormones on the outcome of implant therapy p. 17
Prema Sukumaran, Dionetta Delitta Dionysius, Wei Cheong Ngeow, Chuey Chuan Tan, Mohd Zamri Hussin
DOI:10.4103/jdi.jdi_23_21  
Dental implants require healthy bone for successful osseointegration. However, bone health can become compromised by aging and/or the presence of underlying medical conditions. The severity and complications associated with these medical conditions usually indicate that they require medication for successful management. Some of these medications may undoubtedly exert effects on bone through direct or indirect mechanisms and, therefore, may also affect osseointegration. These include antihypertensive drugs, oral hypoglycemic agents/insulin, hormones (corticosteroid, thyroxin, and tamoxifen), and anti-resorptive agents including bisphosphonates and anti-angiogenic agents. Part two of this paper reviews the current knowledge regarding the effects of corticosteroids, thyroxin, and tamoxifen on the outcome of implant therapy.
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ORIGINAL ARTICLES Top

Marginal bone change, survival and biological complications around dental implants with a platform switched, Morse taper connection, and a medium rough surface in a sample of regular compliers patients p. 24
Maria Costanza Soldini, Filippo Trentin, Ramon Pons Calabuig
DOI:10.4103/jdi.jdi_29_21  
Context: Marginal bone loss around implants still is difficult to avoid and the great influence of the size of the implant/abutment micro-gap on crestal bone level maintenance have been reported in the literature. The internal conical Morse taper connection has been demonstrated to be an effective system for minimizing inflammatory reactions and maximizing peri-implant bone stability. Aims: The primary aim of this study was to evaluate the marginal bone change around dental implants with a platform-switched (PS) Morse taper connection and a medium rough surface over a 4-year follow-up period. Settings and Design: The data for this study were obtained from the clinical records of a private periodontal practice exclusively in Periodontics and Implantology (Vicenza, Italy), treated by one EFP certified periodontist (C.S). The same operator (C.S) performed all the surgeries. Subjects and Methods: Marginal bone loss around PS Morse taper connection implants was retrospectively analysed on standardized radiographs after 1 year and 4 years from the prosthesis connection. Statistical Analysis Used: The statistical unit of observation was the single implant. The influence on MBC of the number of implants for the same patient was tested using the Kruskal Wallis non parametric test. The main effects of the follow-up times (T1 and T4) and of each individual factor on MBC were evaluated using the non-parametric Wilcoxon and Mann-Whitney tests respectively. The interaction effect between follow-up time and each individual factor was graphically tested considering the MBC median values in the time level for each factor. Statistical significance was taken at the ≤0.05 level (two-sided). All analyses were performed using the STATA/IC for Windows, version 14.2. Results: Ninety implants were examined in fifty patients. Mean bone change was −0.06 ± 0.31 mm after 1 year and −0.2 ± 0.45 mm after 4 years. The cumulative survival rate at 4 years was 100%, and a low prevalence of implants with clinical signs of mucositis (12.2%) or peri-implantitis (1.1%) was reported. Conclusions: In implants where the prosthesis is correctly place and the patient are compliers to their maintenance therapy, the contemporary presence of a Morse taper connection and a switching platform seems to offer good results for the maintenance of peri-implant bone in the short and medium term.
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Rehabilitation of edentulous posterior maxilla using lateral disc implants avoiding ridge augmentation in cases with inadequate bone height: A clinical evaluation p. 31
Sanjay Kumar Roy Chowdhury, R Arunkumar Shadamarshan, Rajkumar Krishnaprabhu
DOI:10.4103/jdi.jdi_19_21  
Context: Implant-retained prosthodontic rehabilitation of the posterior maxilla is challenging owing to the compromised characteristics of the residual alveolar bone which might require several adjunctive surgical procedures to augment the available alveolar bone. Aims: This study aims to evaluate the outcome of rehabilitated maxillary posterior edentulous space with lateral disc implants in subjects with inadequate bone height. Subject and Methods: Forty patients with edentulous span in posterior maxilla with inadequate volume of bone were rehabilitated with lateral disc implant-retained prosthesis. Follow-up was undertaken at the end of 06, 12, 24, and 36 months by allocating the implants into the groups assessed according to the Misch Implant quality scale. A total of 6 Single disc, 22 Double disc, and 12 triple disc implants were placed. Statistical Analysis Used: Descriptive statistics. Results: At the end of 06 months, 96.6% were in Group 1, 3.3% were assessed to be in Group 2. At 12 months, 95% were in Group 1, 1.6% in Group 2, and 3.3% in Group 3. At 24 months, 95% were in Group 1, 3.3% were in Group 2, and 1.6% were in Group 3. At 36 months, 96.6% were assessed in Group 1 while 1.6% each was in Group 2 and 4. Conclusions: A clinical success of 98.4% has been established and is concluded that Lateral disc implants provide a viable alternative to the contemporary management protocol involving a sinus lift.
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Comparative evaluation of bone density changes around root-form, threaded collar, two-piece endosseous implants at three different levels as influenced by early loading and conventional loading protocols using cone-beam computed tomography: An in vivo study p. 38
Shuja Mohammed Khan, Manoj Kumar, Gaurav Issar, Manu Dhillon, T Soorya Poduval, Shweta Tyagi
DOI:10.4103/jdi.jdi_21_21  
Background: Understanding the changes in bone density after insertion of dental implants and their relation to immediate/early loading is essential to achieving improvements in their survival rate. Histological investigations of the bone bed in humans are limited, which in turn hampers opportunities to deepen knowledge about the remodeling process around dental implants. Purpose: The aim of this pilot study was to comparatively evaluate the bone density changes around root-form, threaded collar, two-piece endosseous implants at three different levels as influenced by early and conventional protocols using cone-beam computed tomography (CBCT). Methodology: Twenty implants were placed in 20 patients who were randomly assigned to two groups. Group A (n = 10 implants, 10 patients) received conventional loading protocol and Group B (n = 10 implants, 10 patients) followed early loading protocol following implant placement. Bone density changes were evaluated and compared as influenced by early and conventional protocols using CBCT (gray values).The gray values were measured at the apical level, middle region of radiological implant length, and at the crestal level. The measurements were made immediately (T0) and 36 weeks (T1) post implant placement. Results: Intergroup comparison of bone density changes was done between Group A (conventional loading) and Group B (early loading) from immediate post implant placement to 36 weeks post implant placement follow-up. From immediate post implant placement to follow-up, significant difference was seen in bone density of Group A and Group B at apical and middle levels as P < 0.05, but at crestal level, no significant difference was seen. Conclusion: Under the conditions of this study, early loading significantly densified more bone as compared to conventional loading. Further studies are required to determine CBCT gray values and its correlation with computed tomography Hounsfield units for quantification of the bone.
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Effect of multiple reuse of commonly used implant analogs on the dimensional accuracy and the marginal gap between analog and abutment – An in vitro study p. 45
Ravi Shankar Yalavarthy, Jagadeesh Naidu Alla, Srinivas Kalluri, Shiva Shankar Mahadevan, M Hari Krishna, P Shameen Kumar
DOI:10.4103/jdi.jdi_34_21  
Statement of Problem: During the impression procedure, the implant's exact position in the oral cavity is transferred into the cast using impression post and implant analog. As the implant, analog is a lab component, it can be reused multiple times. Reuse of implant analogs may be desirable for both environmental and financial aspects. When implant analogs are reused, it is important to be assured that they are as accurate as new ones. Reusing of implant analog results in loss of precision which is the major key factor in the failure of implant prosthesis. Purpose of the Study: The purpose of the present in vitro study is to assess the effect of multiple reuse of implant analogs of three different materials (SS, Ti, Al) on the dimensional accuracy (external and internal diameter) of implant analogs and the marginal gap between analog and abutment by using two die materials at different time intervals (0, 3rd, 6th, 9th, and 12th). Materials and Methods: Three commonly used implant analog materials (stainless steel, titanium, and aluminum) and two type – IV die stone materials (Kalrock and Zhermack elite) are used to make the samples. A total of sixty implant analogs (20 each), sixty corresponding abutments (20 each) and 720 screws (240 each) were taken, which includes stainless steel, titanium, and aluminum manufactured by Adin, Genesis, and Equinox/Myriad plus, respectively. Addition silicone (light body consistency) was used to make an impression for the internal thread of implant analogues. The obtained samples are tested for external diameter and internal diameter of implant analogues, the marginal gap between analogue and abutment while reusing the implant analogues at the interval of times (0, 3rd, 6th, 9th, and 12th) using a stereomicroscope at ×50. Here the measured values at “0” interval were considered as the control group. The values obtained were statistically analyzed using the one-way ANOVA, independent t-test, and dependent t-test for multiple comparisons. Results: Based on the results obtained, there was no change in the external diameter of three materials of implant analog in both die materials. There was an increase in the internal diameter of implant analogs in which the aluminum material exhibits more increase from 0 to 12th interval, and there was an increase discrepancy in the marginal gap between implant analog and abutment in which the aluminum material has more increase from 0 to 12th interval followed by the stainless steel and titanium implant analogs in both die materials. In between the two die materials, no significant difference was observed in all three parameters. Conclusion: From the study, the following inferences are drawn: that titanium implant analogs can be used more than three times but not more than six times, stainless steel implant analogs can be used for not more than three times, and the aluminum implant analogs can be used for one time only. Hence, among the three materials, titanium implant analogs were most efficient for reuse. Clinical implications: Micromovements of the abutment screw due to discrepancy or loss of surface details of threads of implant analog leads to micro-leakage and bacterial infiltration due to marginal gap discrepancy which further causes increased inflammation at the connection level contributing to a marginal bone loss that may affect the long-term success of implant prosthesis/implant.
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Novel alternative use of surgical guides in full-mouth implant rehabilitation cases: A case series p. 54
Roshan P Thumati, Prafulla Thumati, Srikar Comandur
DOI:10.4103/jdi.jdi_1_22  
Surgical guides (SGs) have been commonly used in full-mouth rehabilitation and numerous advances have been adopted in their development. However, they have been restricted to implant placement and are later rendered useless. They further add to the burden of biological waste management following their limited use. The quantum of technologies and materials used to make us ponder if they can be used further. This article establishes different ways of using SG in different stages of prosthetic phase of treatment by demonstrating the procedures clinically. It gives us an insight into how the guides can be used for implant localization and exposure during the secondary surgical phase and also during impression making, thereby enhancing the treatment outcome.
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CASE REPORTS Top

Socket-shield technique for immediate implant placement with immediate and delayed loading method: Two case reports p. 58
Oliver Jacob, Manab Kosala, Deepak Sharma, Goutam Dilip Nanavati
DOI:10.4103/jdi.jdi_35_20  
Immediate implant placement is becoming a routine procedure in esthetic dentistry. The need for placing the implant immediately post extraction helps reduce the alveolar ridge resorption and also maintain good soft-tissue contours post placing the implant and during rehabilitation. However, a cause of concern occurs when the buccal cortical plate is thin, especially in the upper anterior region. This poses a direct implication in the maintenance of primary stability and buccal contour of both hard and soft tissues, thus compromising esthetics. The socket-shield technique (SST) is a recent advancement in placing immediate implant post extraction. The maintenance of the buccal root section helps retain both the compromised buccal cortical plate and soft-tissue contour, thus providing a better esthetic profile. In view of the same, two patients were provided immediate implants with SST; one with immediate loading of implant and other with delayed loading method, and postoperative radiographic analysis was carried out to evaluate bone density around the implant.
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All-on-four treatment with narrow platform implants in reduced restorative space for moderate atrophic edentulous ridge p. 63
Farhan Durrani, Aishwarya Pandey, Preeti Singh, Samidha Pandey, Rakhshinda Nahid
DOI:10.4103/jdi.jdi_25_21  
The use of dental implants to treat edentulous maxilla and mandible is a well-accepted concept in modern dentistry. However, it is difficult and challenging in atrophic jaws. All-on-four implant concept is an alternative for resorbed jaws, as it obviates extensive bone grafting and waiting time and often provides immediate function. In our article, we describe the use of narrow platform implants (3.3 mm) for a moderate atrophic complete edentulous case with the above concept. The studies with narrow-diameter implants for complete reconstruction are inadequately reported. We followed our case for 3 years after the delivery of final prosthesis.
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CASE SERIES Top

Pontic site development by modified vascularized interpositional periosteal-connective tissue graft: A case series p. 69
Arifa Areej Farooqui, AB Tarun Kumar, MG Triveni, Rucha Shah
DOI:10.4103/jdi.jdi_31_21  
Ridge resorption is unavoidable sequelae of tooth extraction, which leads to soft and hard tissue deficiencies and formation of black triangles. Pedicled grafts inherently have advantage of intact vascular supply over free conventional grafts. A vascularized interpositional periosteal-connective tissue (VIP-CT) graft comprises pedicled connective tissue which is rotated anteriorly to the recipient site. It maintains intact vascular supply thus minimizes chances of graft necrosis and the amount of graft shrinkage. The objective of this case series was to achieve stable, esthetically pleasing pontic site using VIP-CT graft in the anterior maxillary region. In the present case series, the pontic site was developed successfully in three patients having ridge deficiency using a modified approach of VIP-CT. After soft-tissue augmentation, the site was altered by placing a cantilevered provisional ovate pontic. Once the emergence profile had achieved by molding the grafted area, permanent restoration using the adjacent implant as an abutment was delivered to patient. Esthetically pleasing anterior restorations, satisfying the patient's esthetic demands were obtained, and results were found stable up to a period of 9–24 months and thus can be concluded that modified VIP-CT is a predictable approach in anterior esthetic areas to enhance the emergence profile.
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