Search Results (28)

Background/Objective: Advanced peri-implantitis presents a significant challenge in contemporary implant dentistry and sometimes necessitates implant removal when regenerative therapies are no longer reliable. Protocols for staged bone reconstruction, re-implantation, and definitive prosthetic rehabilitation following peri-implantitis continue to evolve. This study aims to present a clinical case of advanced peri-implantitis with vertical interproximal bone loss managed with a staged surgical and prosthetic approach and review current concepts in implant removal, bone regeneration, re-implantation, and soft-tissue management. Methods: A patient with peri-implantitis affecting two maxillary implants underwent treatment over one year. The initial surgical stage included removal of the failing implants and reconstruction of the defects using guided bone regeneration with a composite graft of 50% xenogeneic bone substitute and 50% autogenous bone, covered by a barrier membrane. After six months of healing, a second surgical stage was performed, involving placement of two new implants in positions 2.2 and 2.4, additional bone augmentation, and soft tissue grafting to enhance soft tissue volume and the width of keratinized gingiva following mucogingival line rebounce. After an additional six months of osseointegration, full maxillary prosthetic rehabilitation was completed in August 2025. Results: Clinical and radiographic assessments demonstrated successful bone regeneration, stable implant integration, adequate peri-implant soft-tissue conditions, and favorable functional and esthetic outcomes at follow-up. The case is discussed in the context of current evidence regarding indications for implant removal, regenerative strategies after explantation, timing of re-implantation, and the importance of keratinized gingiva and prosthetic design in long-term peri-implant health. Conclusions: Staged explantation, guided bone regeneration, delayed re-implantation, and comprehensive soft-tissue and prosthetic management may represent a viable treatment strategy in selected cases of advanced peri-implantitis. Full article

Peri-implantitis (PI) is characterized by inflammatory tissue destruction and alveolar bone loss surrounding dental implants, posing clinical challenges. To promote bone regeneration, clinicians often use resorbable or non-resorbable membranes in combination with bone grafts or biologic agents. Despite their widespread application in PI management, the clinical efficacy of these approaches remains uncertain. Therefore, this study aims to evaluate the role of membrane-assisted regenerative therapy in the management of PI. A systematic literature search was conducted in PubMed, Scopus, Cochrane Library, and Google Scholar following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines, with the protocol registered in PROSPERO (CRD420251089276). Sixty-nine studies met the inclusion criteria. The primary outcomes assessed were bone-fill gain and reduction in probing pocket depth (PPD). Although some studies reported improved bone-fill and PPD reduction with membrane-assisted regenerative therapy, the findings were not consistently significant. Future research should validate the clinical efficacy of membranes through well-designed randomized trials and develop advanced decontamination techniques and implant surface modifications that could enhance treatment predictability and patient outcomes. Overall, while membranes show potential clinical value in regenerative therapy, their necessity remains uncertain owing to variability in the current evidence. Full article

Peri-implantitis (PI) presents a growing challenge in implant dentistry, with regenerative surgical approaches often incorporating barrier membranes despite the uncertainty of their clinical value. This systematic review and meta-analysis of in vivo studies aimed to evaluate the efficacy of barrier membranes in the reconstructive surgical treatment of PI. A comprehensive electronic search was performed in PubMed, Scopus, Google Scholar, and the Cochrane Library, covering studies published from 1990 to 2024. The protocol followed PRISMA guidelines and was registered in PROSPERO (CRD42025625417). Eligible studies included in vivo investigations comparing regenerative procedures with and without membrane use, with a minimum follow-up of 6 months and at least 10 implants per study. Risk of bias (RoB) was assessed using the Cochrane RoB tool. The meta-analysis was conducted using a random-effects model and included 15 studies comprising 560 patients. Although not consistently statistically significant, the findings suggested that membrane use may offer enhanced outcomes in terms of probing pocket depth (PPD) reduction and marginal bone level (MLB) gain. The evidence was limited by high clinical heterogeneity, variability in outcome definitions, and short follow-up durations. While membranes are commonly utilized, current evidence does not justify their routine use. Further well-designed, long-term clinical trials are needed to establish specific indications and optimize treatment strategies. Full article

The biologic response following the insertion of dental implants is a widely studied process. Recent research has highlighted the importance of implant surface topography and chemistry as highly influential factors in consolidating the dental implant with the surrounding biological environment. The hydrophilicity, or wettability, of dental implants plays a pivotal role in these interactions and successful osseointegration. A more well-established factor that can also influence the development of the tissue–implant interface is exposure to tobacco smoke. While the negative impact of smoking on the biological response of the tissue is clear, there has been no research evaluating the impact that tobacco smoke can have directly on the surface chemistry of dental implants. The present study aimed to explore the effect of smoking on implant surface chemistry and wettability in vitro. Five different implant disks (Ti-Mach, Ti-SLA, Ti-Alloy, Zirc-1 and Zirc-2) were subjected to contamination with tobacco smoke using a portable smoke infuser with dome enclosure. Occasional smoking (5×/day 10 min each for 3 days) and heavy smoking (20×/day for 10 min each for 10 days) were simulated. The wettability of the implant disks was evaluated via the contact angle technique using artificial blood and albumin, as well as saline as a control. It was determined that the contamination of implant surfaces due to smoking produces changes in the surface chemistry and wettability. Changes in the surface hydrophilicity differed based on the implant material. Within the constraints of this investigation, tobacco smoke improved the hydrophilicity of titanium surfaces but worsened that of ceramic surfaces when utilizing the testing solutions. Different implant surfaces exhibit different wetting behavior following contamination with nicotine smoke. This might have an impact on the treatment of peri-implantitis in smokers due to changes in implant surface hydrophilicity, which can affect the re-osseointegration process. Full article

Background and Objectives: The goal of this study was to introduce a novel device, the iMPACT implant planer, designed to machine (create a complete smooth surface) contaminated implant surfaces intraorally, promoting peri-implant tissue healing and possible re-osseointegration, and the new Quadrant protocol, evaluating them in vitro and clinically. The null hypothesis was that there would be no improvement in the clinical parameters for the implants with peri-implantitis (PI) treated with the new protocol and tool. Materials and Methods: The Quadrant protocol was used in conjunction with the iMPACT tool, which primarily functions to remove biofilm and microbial contaminants from the exposed implant surface, while simultaneously preparing the surface through standardized implantoplasty, thereby enhancing the potential for re-osseointegration. An in vitro analysis was developed, and three medium/long-term cases were presented, detailing the procedures and outcomes. Results: The in vitro assessment showed smooth surfaces after treatment. Different areas presented minimal particles (<1 μm) on the implant surface, with a high content of titanium (Ti) and tungsten (W). In case 1, severe and advanced peri-implantitis around implants #46 and #47 was found. A combination of resective (Quadrant + iMPACT) and regenerative surgery was used for treatment, along with a buccal single flap (BSF). Significant clinical and radiographic improvements were observed at 14 and 43 months postoperatively, including vertical bone gain with re-osseointegration and stable probing depths (PDs). In the second case, a severe PI and prosthesis instability were observed. Resective (Quadrant + iMPACT) and regenerative procedures were applied. At 3 and 12 months postoperatively, clinical and radiographic evaluations demonstrated significant improvements with re-osseointegration, including PDs reduced to 0–1 mm and a vertical bone gain of approximately 6.5 mm. In case 3, mandibular implants from 42 to 47 exhibited inflammation, suppuration, and moderate-to-severe bone loss. Just resective surgery (Quadrant + iMPACT), without grafting, was performed. At 6- and 12-month follow-ups, clinical and radiographic assessments showed the resolution of inflammation, stable bone levels, and healthy peri-implant gingiva. Conclusions: Favorable outcomes were achieved using the iMPACT and Quadrant protocols in the three clinical cases, resulting in re-osseointegration when combined with regenerative procedures. The favorable medium/long-term outcomes achieved, despite the patient’s complex medical history and, at times, inconsistent oral hygiene, underscore the potential efficacy of such interventions. Full article

Objectives: This study aims to investigate the underlying causes of dental implant failure, focusing on implant-related complications and associated risk factors. Understanding these factors will help improve treatment planning and enhance implant success rates. Methods: A retrospective case-control study was conducted using clinical, medical, surgical, and radiographic records of patients who underwent dental implant removal due to complications. Key factors analyzed included patient-related variables (age, gender, medical conditions, periodontal disease), implant-related factors (implant site, implant system, restoration status), and procedural aspects (previous surgical interventions and reasons for implant removal). Results: The findings revealed that implant type (p = 0.004) and type of restoration (p = 0.001) significantly influenced implant survival. Gender (p = 0.001), medical conditions, smoking status (p = 0.004), and restoration status (p = 0.005) were significantly associated with specific failure mechanisms. Lack of osseointegration (36.4%) and absence of primary stability (22.4%) were the predominant causes of implant failure. Prior surgical interventions (p = 0.001) and decisions for re-implantation (p = 0.005) significantly affected implant removal frequency. Conclusions: Implant survival is influenced by multiple factors, with implant type, restoration type, and gender playing key roles in failure outcomes. Patient-specific risk assessment, particularly regarding medical conditions and smoking, meticulous surgical technique, and appropriate prosthetic planning, is vital for improving implant longevity and minimizing failure rates. Full article

Background/Objectives: This literature review aims to systematically analyze the efficacy of electrolytic cleaning for treating peri-implantitis, including its impact on disease resolution, re-osseointegration of treated implants, and peri-implantitis recurrence. It also compares various study and treatment protocols used in the selected papers. Methods: A comprehensive search was conducted in MEDLINE (via PubMed) and the Cochrane Central Register of Controlled Trials using the keywords “electrolytic cleaning implant” or “GalvoSurge”. Studies published until 31 December 2024 were considered for inclusion. Results: Out of 141 articles retrieved, four publications were selected for the review. These studies were analyzed for implant type, number, evaluation methods, observation periods, surgical procedures, and additional treatments. Disease resolution was reported in one study, while peri-implantitis recurred in the remaining studies. However, re-osseointegration of treated implants was observed in all selected papers. Conclusions: Due to the limited and heterogeneous nature of the studies, it is difficult to draw definitive conclusions about the effectiveness of electrolytic cleaning as a treatment for peri-implantitis. To ensure consistent trial outcomes and improve predictability, clear clinical guidelines and surgical protocols for electrolytic decontamination are essential. Full article

The metastable β-Ti21S alloy exhibits a lower elastic modulus than Ti-6Al-4V ELI while maintaining high mechanical strength and ductility. To address stress shielding, this study explores the integration of lattice structures within prosthetics, which is made possible through additive manufacturing. Continuous adhesion between the implant and bone is essential; therefore, auxetic bow-tie structures with a negative Poisson’s ratio are proposed for regions under tensile stress, while Triply Periodic Minimal Surface (TPMS) structures with a positive Poisson’s ratio are recommended for areas under compressive stress. This research examines the manufacturability and quasi-static mechanical behaviour of two auxetic bow-tie (AUX 2.5 and AUX 3.5) and two TPMS structures (TPMS 2.5 and TPMS 1.5) in β-Ti21S alloy produced via laser powder bed fusion. Micro-CT reveals printability issues in TPMS 1.5, affecting pore size and reducing fatigue resistance compared to TPMS 2.5. AUX 3.5’s low stiffness matches cancellous bone but shows insufficient yield strength and fatigue resistance for femoral implants. Biological tests confirm non-toxicity and enhanced cell activity in β-Ti21S structures. The study concludes that the β-Ti21S alloy, especially with TPMS 2.5 structures, demonstrates promising mechanical and biological properties for femoral implants. However, challenges like poor printability in TPMS 1.5 are acknowledged and should be addressed in future research. Full article

This study aimed to describe a case of simultaneous guided bone regeneration (GBR) and implant placement in a patient with prior aesthetic implant failure, focusing on achieving optimal aesthetic and functional outcomes, and to perform a literature review of the current evidence. A 38-year-old male presented with an improperly positioned implant at the level of the right upper central (tooth 2.1), leading to aesthetic and functional issues. The initial assessment included a panoramic radiograph revealing marginal bone loss and an enlarged peri-implant space, necessitating implant removal. Following implant removal and provisional restoration, the patient was re-evaluated for subsequent therapeutic treatments. The patient underwent orthodontic treatment to improve mesio-distal spacing, followed by surgical intervention involving GBR and simultaneous implant placement. The GBR procedure utilised bone substitutes and resorbable membranes, with soft tissue augmentation conducted subsequently. The surgical intervention involved local anaesthesia, flap design, defect assessment, and palatally oriented implant placement. GBR was then performed. After six months, implant uncovering and soft tissue augmentation were conducted. The implant was loaded with a screwed restoration following complete hard and soft tissue healing. The patient was monitored every six months for two years, then annually. At the 10-year follow-up, no signs of bone resorption or soft tissue inflammation were observed. This case demonstrated that GBR and simultaneous implant placement, with the application of advanced biomaterials, effectively promoted osseointegration and maintained aesthetic and functional stability over a decade. Full article

Background: Implant replacement is among the treatment options for severe peri-implantitis. The aim of this single-cohort study was to evaluate the feasibility of replacing compromised implants affected by advanced peri-implantitis with new implants with a porous trabecular metal (TM) structure. Materials and Methods: Patients with one or more implants in the posterior region showing a defect depth >50% of implant length, measured from the residual crest, were consecutively included. Two months after implant removal, patients received a TM implant combined with a xenograft and a resorbable membrane. The implant stability quotient (ISQ) was measured at placement and re-assessed five months later (at uncovering), then after 6, 12, and 24 months of function. Marginal bone loss was radiographically evaluated. Results: Twenty consecutive cases were included. One patient dropped out due to COVID-19 infection, and nineteen cases were evaluated up to 24 months. At placement, the mean ISQ was 53.08 ± 13.65 (standard deviation), which increased significantly to 69.74 ± 9.01 after five months of healing (p < 0.001) and to 78.00 ± 7.29 after six months of loading (p < 0.001). Thereafter, the ISQ remained stable for up to 24 months (80.55 ± 4.73). All implants successfully osseointegrated and were restored as planned. After two years, the average marginal bone level change was −0.41 ± 0.38 mm (95% confidence interval −0.60, −0.21), which was limited yet significantly different from the baseline (p < 0.05). Conclusions: The treatment of advanced peri-implant defects using TM implants inserted two months after explantation in combination with guided bone regeneration may achieve successful outcomes up to two years follow-up, even in the presence of low primary stability. Full article

Peri-implantitis is an inflammatory lesion leading to bone destruction resulting from bacterial infection and biofilm formation. Treatments of peri-implantitis aim at bacterial controls and decontamination to promote re-osseointegration. The present study aimed to assess the decontamination of biofilm and the osseointegration of titanium discs in a rabbit tibia model. Discs were immersed in culture medium inoculated with Staphylococcus aureus and incubated at 37 °C for 24 h and allocated to different treatments (n = five per group). The decontamination methods were an air-polishing system, 0.12% chlorhexidine rinse, and Er:Yag laser treatments. Each disc from the experimental groups was observed using scanning electron micrography. The rest of the discs were then implanted in four male New Zealand rabbits. Histological and radiographic evaluations were performed. For the quantification of bone density in radiographic data, the fractal dimension (FD) and mean grayscale value (GV) were measured. The Kruskal–Wallis test was used to compare bone density (p < 0.05). Statistically significant differences in FD were observed between the air-polishing treatment with chlorhexidine rinse and the air-polishing treatment with chlorhexidine rinse and Er:Yag laser treatment compared to the contaminated group (p < 0.05). Also, there were statistically significant differences in the results obtained for the group undergoing air-polishing treatment with chlorhexidine rinse and Er:Yag laser treatment compared to the contaminated group (p < 0.05). The decontamination method using air polishing treatment, chlorhexidine rinse, and Er:Yag treatment showed favorable osseointegration with good bone quality. Full article

Introduction: A modular head–neck adapter system may help surgeons restore the proximal hip biomechanics in revision hip arthroplasty. However, the clinical and radiographic 5-year outcomes of the system are still scarcely reported. The aim of this study is the assessment of (1) complications and survival rates, (2) clinical and (3) radiological outcomes of the modular head–neck adapter system with a ceramic head in revision hip arthroplasty at 5 years. Methods: 32 revision hip arthroplasties using a modular head–neck adapter system and a ceramic head were retrospectively recorded. Preoperative demographic and implant features were collected. Clinical and radiographic outcomes, failures and reasons for re-revisions were recorded at the last follow-up. Results: A mean follow-up of 59.8 ± 26 months was achieved. The survival rate was 90.6% at 5 years. Post-operative complications occurred in nine cases (28.1%): two dislocations (6.2%), one aseptic cup loosening (3.1%) requiring re-revision, one (3.1%) persistent pelvic pseudotumor requiring embolization. No mechanical failures of the adapter or ceramic head occurred. The mean post-operative HHS score was 84.4 points. Thirteen cases (40.6%) showed optimal radiographic cup osseointegration, and 17 hips (53.1%) showed valid stem osseointegration. The mean post-operative femoral offset was 48.84 mm, larger than the contralateral side (p = 0.02). The post-operative lateralization of the hip joint was 38.09 mm, close to the contralateral side (p = 0.4). Conclusions: In revisions, the modular head–neck adapter system with ceramic head provided good clinical outcomes and acceptable radiographic reconstruction of hip biomechanics, with a survival rate of 87.9% at 5 years. Full article

Tooth Shell Technique (TST) with the use of autologous dentin has proven to be a suitable method of grafting in the context of lateral ridge augmentation. This present feasibility study aimed to retrospectively evaluate the preservation by lyophilization of processed dentin. Thus, the frozen stored processed dentin matrix (FST: 19 patients with 26 implants) was re-examined with that of processed teeth used immediately after extraction (IUT: 23 patients with 32 implants). Parameters of biological complications, horizontal hard tissue loss, osseointegration, and buccal lamella integrity were used for evaluation. For complications, the observation period was 5 months. Only one graft was lost (IUT group). In the area of minor complications, without the loss of an implant or augmentation, there were two cases of wound dehiscence and one case with inflammation and suppuration (IUT: n = 3, FST: n = 0). Osseointegration and integrity of the buccal lamella were present in all implants without exception. Statistically, there was no difference between the groups studied for the mean resorption of the crestal width and the buccal lamella. Results of this study show that prepared autologous dentin preserved with a conventional freezer had no disadvantage compared to immediately use autologous dentin in terms of complications and graft resorption in the context of TST. Full article

Introduction: Two-stage revision is the gold standard for chronic periprosthetic joint infection (PJI). The removal of well-fixed implants, especially the femoral component, can be extremely difficult and additional osteotomies may be needed, which is time-consuming and results in bone stock loss. When the femoral stem is osseointegrated, there is no clear indication for the use of partial two-stage revision. The primary objective was to assess infection eradication after surgery. Methods: Retrospective study of specific case series. A total of eight patients with a chronic uncemented PJI, in the setting of complex revision surgeries, were treated with partial two-stage revision, which included selective retention of the well-fixed femoral component and complete acetabular removal. Stem retention was carried out regardless of the bacteria or associated comorbidities. Results: All patients were re-revision cases with at least two previous surgeries (range, 2–4). Complex revisions were performed in five cases (non-articulated spacer) and simple revisions in three cases (articulated spacer). The minimum follow-up time was 24 months (range, 24–132 months). The infection eradication rate at final follow-up was 100%. Conclusion: Partial two-stage reconstruction is a promising technique for the treatment of chronic PJI in patients with a well-fixed stem and complex re-revision acetabular procedures. Further prospective studies and prolonged follow-ups are required to confirm our results. Full article

Tooth shell technique (TST) using autologous dentine is possible with lateral ridge augmentation while avoiding a donor region. This study aimed to clarify whether the use of periodontally compromised teeth (PCT) leads to similar results compared to non-periodontally compromised teeth (NPCT). In this retrospective study, the dentin matrix of 41 patients (PCT: n = 19 with 29 implants; NPCT: n = 22, with 29 implants) was used for TST. All cases were re-examined. Outcome parameters were biological complications, horizontal hard tissue loss, osseointegration, and the integrity of the buccal lamella. Only in one case in the PCT group, a graft was lost. In three cases, minor complications were identified, including two cases of wound dehiscence and one case of inflammation with suppuration (PCT: n = 1, NPCT: n = 3). All implants, except the one with the severe complication, were osseointegrated and the integrity of the buccal bone lamella was preserved. Mean difference of the resorption of the crestal width and the buccal lamella did not differ statistically between the two groups. TST using PCT showed results comparable to those of NPCT in terms of complications and graft resorption. Processed dentin matrix from PCT can be used and applied with predictable results for bone grafting, utilizing TST. Full article