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Soft Tissue Inflammation (soft + tissue_inflammation)

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Medical Sciences	100%

Selected Abstracts

Immunohistochemical characteristics of inflammatory lesions at implants

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2003
Federico Gualini
Abstract Objective: The aim of the present investigation was to study some immunohistochemical features of peri-implant mucositis and peri-implantitis lesions. Materials and methods: Two groups of subjects (Groups A and B) were included. Group A consisted of 10 partially edentulous subjects (eight females and two males; 45,72 years of age) who had been restored with implants (Brånemark System®, Nobel Biocare AB, Göteborg, Sweden). The implants had been in function between 2 and 5 years. In each subject, one implant site demonstrating signs of peri-implant mucositis, i.e. soft tissue inflammation but no bone loss, was selected. The site was anaesthetized and a soft tissue biopsy was collected. In Group B, six subjects were included. They had been restored with implants (Brånemark System®, Nobel Biocare AB, Göteborg, Sweden) between 5 and 11 years prior to the current study. In each individual ,,1 implant site exhibited signs of peri-implantitis and was selected for biopsy. All sites of peri-implantitis had (i) a history of continuous marginal bone loss (assessed in radiographs), (ii) clinical symptoms of soft tissue inflammation (bleeding on probing and suppuration) but (iii) no implant mobility. From each selected peri-implantitis site a 4 × 4 mm large soft tissue biopsy was obtained. All specimens were snap frozen and prepared for immunohistochemical analysis regarding the proportions of cells positive for the CD3, CD4, CD8, CD19 and elastase markers. Results: Peri-implantitis lesions were considerably larger and contained significantly greater proportions of B cells (CD19+) and elastase-positive cells than mucositis lesions. Peri-implantitis sites, in contrast to sites with mucositis, consistently displayed elastase-positive cells in the central portions of the infiltrate. Conclusion: It is suggested that peri-implantitis lesions exhibit properties that are different from mucositis lesions. [source]

Relative effectiveness of powered and manual toothbrushes in elderly patients with implant-supported mandibular overdentures

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2002
A. Tawse-Smith
Abstract Aim: The aim of this study was to compare the clinical effectiveness of a powered toothbrush (Braun Oral-B Plaque Remover 3-D) and a manual soft toothbrush (Oral-B Squish-grip brush) for the control of supragingival plaque and soft tissue inflammation around implants supporting mandibular overdentures. Material and methods: The study sample involved 40 edentulous subjects, aged 55,80 years, having 2 unsplinted mandibular implants supporting a complete removable overdenture opposed by a maxillary complete denture. In this single-blinded, randomised, cross-over clinical trial, two 6-week experimental phases were separated by a 2-week wash-out period. 2 weeks prior to each experimental phase (pre-entry visits), implant abutments were polished to remove all plaque and a standardised instruction in the use of the toothbrush was given. Modified plaque and bleeding indices were recorded at the start and end of each experimental period. Mean index scores at each phase were analysed using paired t -test, and the mean number of sites showing a change in plaque or mucositis were compared using the Mann-Whitney U -test. Combined data from 2 different implant systems were considered after controlling for implant type. Results: Only minor changes in plaque and bleeding scores were observed following the two test periods. There were no statistically significant differences between the manual and powered toothbrushes. Conclusion: Manual and powered brushes were found to be of comparable efficacy with regard to improvement in peri-implant bleeding and plaque indices. Zusammenfassung Zielsetzung: Untersuchung der klinischen Effektivität einer elektrischen Zahnbürste (Braun Oral-B Plaque Remover 3-D) im Vergleich zu einer weichen Handzahnbürste (Oral-B Squish-grip brush) zur Kontrolle supragingivaler Plaque und Weichgewebsentzündung an Implantaten, die Unterkiefer-Totalprothesen tragen. Material und Methoden: Das Untersuchungskollektiv bestand aus 40 zahnlosen Patienten im Alter zwischen 55 und 80 Jahren, die 2 unverblockte Unterkiefer-Implantate zur Unterstützung einer Totalprothese aufwiesen. Der Oberkiefer war jeweils mit einer total schleimhautgetragenen Prothese versorgt. In dieser einfach verblindeten, randomisierten klinischen Cross-over-Studie wurden 2 6-wöchige experimentelle Phasen von einer 2-wöchigen Auswaschperiode unterbrochen. 2 Wochen vor jeder experimentellen Phase wurden die supragingivalen Implantatflächen von sämtlicher Plaque gereinigt und die Patienten erhielten eine Instruktion im Gebrauch der Zahnbürsten. Modifizierte Plaque- und Blutungsindizes wurden zu Beginn und am Ende jeder experimentellen Phase erhoben. Die Mittelwerte für die Indizes wurden mittels des paarigen t -Tests und die Zahl der Stellen, die eine Veränderung in Plaque und Mucositis aufwiesen, wurden durch den Mann-Whitney U -Test verglichen. Die Daten für 2 Implantatsysteme wurden zusammengefasst, nachdem der Einfluss des Implantatsystems überprüft worden war. Ergebnisse: Es wurden nur geringe Veränderungen der Plaque- und Blutungsindizes am Ende beider Testphasen beobachtet. Ein statistisch signifikanter Unterschied zwischen elektrischer und Handzahnbürste konnte nicht gezeigt werden. Schlussfolgerungen: Hand- und elektrische Zahnbürsten erwiesen sich als gleich effektiv für die Verbesserung periimplantärer Plaque- und Blutungsindizes. Résumé But: Le but de cette étude était de comparer l'efficacité clinique d'une brosse à dent électrique (Plaque remover 3D de Braun Oral B) et une brosse souple manuelle (squish grip d'oral B) pour le contrôle de la plaque supra-gingivale et l'inflammation des tissus mous autour d'implants supportant des overdentures mandibulaires. Matériaux et méthodes: L'échantillon étudié comprenait 40 sujets édentés, âgés de 55 à 80 ans, ayant 2 implants mandibulaires non reliés supportant une overdenture amovible complète et une prothèse maxillaire antagoniste complète. Dans cet essai clinique croisé en aveugle simple, randomisée, 2 phases expérimentales de 6 semaines encadraient une période d'arrêt de 2 semaines. 2 semaines avant chaque phase expérimentale, (visite de pré-entrée), les piliers implantaires étaient polis afin d'éliminer toute la plaque et des instructions standardisées d'utilisation de la brosse étaient données. On notait les indices, de saignement et de plaque modifié, au début et à la fin de chaque période expérimentale. Les notes d'indices moyens à chaque phase étaient analysées par le test t apparié et le nombre moyen de sites présentant une modification de la plaque ou de la mucosite était comparé par le test U de Mann Whitney. Les données combinées des 2 systèmes implantaires étaient considérées après cotrôle pour chaque type d'implant Résultats: De minimes modifications des notes de plaque et de saignement étaient observées après les deux périodes de test. Il n'y avait pas de différences statistiques significatives entre les brosses manuelles et électriques. Conclusion: Les brosses manuelles et électriques ont une efficacité comparable du point de vue de l'amélioration des indices de saignement et de plaque peri-implantaires. [source]

Minimally Invasive Flapless Implant Surgery: A Prospective Multicenter Study

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2005
ODhc, William Becker DDS
ABSTRACT Background: Placement of implants with a minimally invasive flapless approach has the potential to minimize crestal bone loss, soft tissue inflammation, and probing depth adjacent to implants and to minimize surgical time. Purpose: The aim of this multicenter study was to evaluate implant placement using a minimally invasive one-stage flapless technique up to 2 years. Materials and Methods: Fifty-seven patients ranging in age from 24 to 86 years were recruited from three clinical centers (Tucson, AZ, USA; Tel Aviv, Israel; Göteborg, Sweden). Seventy-nine implants were placed. A small, sharp-tipped guiding drill was used to create a precise, minimally invasive initial penetration through the mucosa and into bone (Nobel Biocare, Yorba, Linda, CA, USA). Implants were placed according to the manufacturer's instructions, with minimal countersinking. The parameters evaluated were total surgical time, implant survival, bone quality and quantity, implant position by tooth type, depth from mucosal margin to bone crest, implant length, probing depth, inflammation, and crestal bone changes. At 2 years, for 79 implants placed in 57 patients, the cumulative success rate using a minimally invasive flapless method was 98.7%, indicating the loss of 1 implant. Changes in crestal bone for 77 baseline and follow-up measurements were insignificant (radiograph 1: mean 0.7 mm, SD 0.5 mm, range 2.8 mm, minimum 0.2 mm, maximum 3.0 mm; radiograph 2: mean 0.8 mm, SD 0.5 mm, range 3.4 mm, minimum 0.12 mm, maximum 3.5 mm). Using descriptive statistics for 78 patients (one implant lost), mean changes for probing depth and inflammation were clinically insignificant. The average time for implant placement was 28 minutes (minimum 10 minutes, maximum 60 minutes, SD 13.1 minutes). Average depth from mucosal margin to bone was 3.3 mm (SD 0.7 mm, minimum 2 mm, maximum 5 mm, range 3 mm). Thirty-two implants were placed in maxillae and 47 in mandibles. Conclusions: The results of this study demonstrate that following diagnostic treatment planning criteria, flapless surgery using a minimally invasive technique is a predictable procedure. The benefits of this procedure are lessened surgical time; minimal changes in crestal bone levels, probing depth, and inflammation; perceived minimized bleeding; and lessened postoperative discomfort. [source]

Fixed Implant-Supported Prostheses in Elderly Patients: A 5-Year Retrospective Study of 133 Edentulous Patients Older than 79 Years

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 4 2004
Ingela Engfors DDS
ABSTRACT Background: An increasing number of elderly patients are treated with implants, but results for the elderly patient in terms of implant success and adaptation to implant prostheses are contradictory. Objective: To retrospectively study the 5-year clinical and radiologic performances of fixed implant-supported prostheses placed in edentulous elderly patients and to compare those results with the results of using similar prostheses in a control group of younger patients. Materials and Methods: The study group comprised 133 edentulous patients who were 80 or more years of age and who were consecutively treated with fixed implant-supported prostheses between January 1986 and August 1998. Altogether 761 Brånemark System® implants (Nobel Biocare AB, Göteborg, Sweden) were placed in 139 edentulous jaws. The control group comprised 115 edentulous patients who were younger than 80 years and who were treated consecutively from March 1996 to November 1997 with similar prostheses. In this group 670 implants were placed in 118 edentulous jaws. Information was collected from all postinsertion visits, including the fifth annual checkup, and changes of marginal bone levels were analyzed from intraoral radiographs. Results: The 5-year cumulative survival rate (CSR) for implants in the maxilla was 93.0% in the study group and 92.6% in the control group; the corresponding CSRs for implants in the mandible were 99.5% and 99.7%. The most common complications for patients in the study group were soft tissue inflammation (mucositis) and cheek and lip biting (p < .05) whereas resin veneer fractures were the most common complications for the control group. Overall 5-year marginal bone loss for the study group was 0.7 mm (standard deviation [SD], 0.45) in the upper jaw and 0.6 mm (SD, 0.50) in the lower jaw. Differences in bone levels and bone loss between the two groups did not reach significant levels (p > .05). Conclusions: Implant treatment in the elderly patients showed treatment results comparable to those observed in younger age groups. However, indications of more problems with adaptation could be observed and were reflected in more postinsertion problems. Cleaning problems and associated soft tissue inflammation (mucositis) as well as tongue, lip, and cheek biting were significantly more often observed among the elderly patients (p < .05). [source]

Reconstruction of maxillary and mandibular defects using prefabricated microvascular fibular grafts and osseointegrated dental implants , a prospective study

CLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2004
Claude Jaquiéry
Abstract: The fibular flap can be used for a variety of indications. Recently, the treatment of four patients with severely atrophied upper jaws using a method to prefabricate the vascularized fibular graft has been published. This technique consists of a two-stage operation procedure that allows simultaneous prosthodontic rehabilitation and immediate placement of dental implants. In this paper eight patients with 29 ITI implants (Straumann AG, Waldenburg, Switzerland) who had reconstruction of either the upper or lower jaw are presented. The aim of the study was (i) to evaluate the behavior of the newly formed soft tissue around implants inserted in the fibula by applying periodontal parameters, (ii) to monitor prospectively the integration of the implants in the fibular graft, and (iii) to assess the osseous integration of the fibular graft used for reconstruction of the upper or lower jaw. Two implants failed during the observation time because of avascular bone at the distal end of the fibular graft. Stabilization of the graft, however, was never compromised. Due to the prefabrication firmly attached gingiva-like soft tissue could be provided preventing periimplant soft tissue inflammation and facilitating oral hygiene. After 1 year of observation the mean attachment level was similar to implants placed in original bone whereas vertical bone loss measured radiographically was lower in the present study. This may indicate that the remodeling of a bicortical bone requires a longer period of time compared with the bone of the alveolar crest. The prospective 1-year results are promising but long-term evaluation of periodontal and radiological parameters are required. Résumé Le lambeau péroné peut être utilisé pour une variété d'indications. Récemment le traitement de quatre patients avec une atrophie sévère des mâchoires supérieures et utilisant une méthode pour préfabriquer un greffon péroné vascularisé a été publié. Cette technique consiste en une opération en deux étapes qui permet la réhabilitation prothétique simultanée et le placement immédiat des implants dentaires. Dans ce rapport huit patients avec 29 implants ITI (Straumann AG, Waldenburg, Switzerland) ont eu une reconstruction de la mâchoire supérieure ou inférieure. Le but de cette étude a été 1) d'évaluer le comportement des tissus mous nouvellement formés autour des implants insérés dans le péroné en appliquant les paramètres parodontaux, 2) de suivre d'une manière prospective l'intégration des implants dans le greffon péroné et 3) d'examiner l'intégration osseuse de l'implant péroné utilisé pour la reconstruction de ces mâchoires. Deux implants ont échoué durant la période d'observation parce que l'os alvéolaire n'était pas vasculariséà la partie distale du greffon. La stabilisation du greffon n'a cependant jamais été compromise. La préfabrication d'un tissu ressemblant à de la gencive préfabriquée a permit d'éviter l'inflammation gingivale et de faciliter l'hygiène buccale. Après une année d'observation le niveau d'attache moyen était semblable au niveau des implants placés dans l'os original tandis que la perte osseuse verticale mesurée radiographiquement était inférieure dans l'étude présente. Ceci peut indiquer que le remodelage de l'os bicortical requiert une période plus importante comparée à l'os du rebord alvéolaire. Ces résultats prospectifs à une année sont encourageants mais l'évaluation à long terme des paramètres parodontaux et radiologiques reste encore nécessaire. Zusammenfassung Der Fibula-Lappen kann bei einer Vielzahl von Indikationen angewendet werden. Kürzlich wurde eine Publikation über die Behandlung von vier Patienten mit stark atrophierten Oberkiefern mittels vorfabrizierten vaskularisierten Fibula transplantaten veröffentlicht. Diese Technik besteht aus einer Operation in zwei Phasen, welche die Sofortimplantation von dentalen Implantaten und gleichzeitige prothetische Rekonstruction erlaubt. In diesem Artikel werden acht Patienten mit 29 Implantaten (Straumann AG, Waldenburg, Switzerland), bei welchen entweder eine OK- oder UK-Rekonstruktion durchgeführt wurde, präsentiert. Das Ziel der Studie war (i) das Verhalten des neu gebildeten Gewebes um die Implantate, welche in die Fibula eingesetzt worden waren mittels parodontalen Parametern zu untersuchen, (ii) die Integration der Implantate in das Fibula-Transplantat prospektiv aufzuzeichnen und (iii) die ossäre Integration des für die Rekonstruktion des OK oder UK verwendeten Fibula-Transplantats zu ermitteln. Zwei Implantate zeigten während der Beobachtungsperiode Misserfolge wegen avaskulärem Knochen an den distalen Enden des Fibula-Transplantats. Die Stabilisierung des Transplantats war jedoch niemals beeinträchtigt. Durch die Vorfabrizierung konnten gut angewachsene gingiva-ähnliche Weichgewebe geschaffen werden, welche eine periimplantäre Entzündung der Weichgewebe verhinderten und die Mundhygiene erleichterten. Nach einer Beobachtungszeit von einem Jahr war das mittlere Attachmentniveau ähnlich dem von Implantaten, welche in alveolären Knochen inseriert worden waren, während der radiologisch gemessene Knochenverlust in der vorliegenden Studie geringer war. Dies könnte ein Indiz dafür sein, dass die Remodellierung eines bikortikalen Knochens im Vergleich zum Alveolarknochen längere Zeit benötigt. Die prospektiven Resultate nach einem Jahr sehen vielversprechend aus, aber es muss eine Auswertung der parodontalen und radiologischen Parameter über einen längeren Zeitraum durchgeführt werden. Resumen El colgajo peroneal puede ser usado para una variedad de indicaciones. Recientemente se ha publicado el tratamiento de cuatro pacientes con maxilares superiores severamente atróficos usando un método para prefabricar el injerto peroneal vascularizado. Esta técnica consiste en un procedimiento de operación de dos fases que permite la rehabilitación prostodóntica y la colocación inmediata de implantes dentales simultáneamente. En este artículo se presentan ocho pacientes con 29 implantes ITI (Strauman AG, Waldenburg) teniendo una reconstrucción de tanto el maxilar superior como del inferior. La intención del presente estudio fue (i) evaluar el comportamiento de del tejido blando neoformado alrededor de los implantes insertados en la tibia aplicando parámetros periodontales, (ii) monitorizar prospectivamente la integración de los implantes en el injerto perineal y (iii) valorar la integración ósea del injerto perineal usado para la reconstrucción del maxilar superior o inferior. Dos implantes fracasaron durante el periodo de observación debido a hueso sin vascularización en el final distal del injerto perineal. De todos modos, la estabilización del injerto no se vio nunca comprometida. Debido a la prefabricación se pudo suministrar un tejido blando tipo encía adherida previniendo inflamación del tejido blando periimplantario y facilitando la higiene oral. Tras un año de observación el nivel de inserción medio fue similar a los implantes insertados en las áreas de hueso original mientras que la pérdida de hueso vertical medida radiograficamente fue menor en el presente estudio. Esto puede indicar que el remodelado de un hueso bicortical requiere un periodo mas largo de tiempo comparado con el hueso de la cresta alveolar. Los resultados prospectivos de un año son prometedores pero se requieren evaluaciones de los parámetros periodontales y radiológicos a largo plazo. [source]