RESUMEN
The facial soft tissue form of dental implants is influenced by a variety of biologic, surgical, and restorative factors. Implants and/or restorative components that are positioned facially present a challenge to created ideal facial soft tissue contours. The following case reports display how modification of the restorative components, namely, abutment and crown, will influence the soft tissue height and contour when minor tissue discrepancies exist due to nonideal implant placement.
Asunto(s)
Pilares Dentales , Implantes Dentales , Diseño de Prótesis Dental , Coronas , Encía/patología , Humanos , Propiedades de SuperficieRESUMEN
With the increasing demands of patients and the profession to maximize esthetic outcomes and minimize the number of procedures, clinicians must consider the use of immediate placement of implants into extraction sockets. Despite atraumatic extraction techniques, many cases present with a non-intact extraction socket, with bone deficiency in the coronal or apical aspect of the socket. In cases of immediate placement, an intact socket and guided bone regeneration procedures are often prerequisites to a successful esthetic outcome. In most cases, these grafting techniques can be performed at the time of immediate placement. Certain cases, however, have undergone such extensive bone and soft-tissue destruction that implants cannot be placed immediately and hard- and/or soft-tissue augmentation is required prior to implant placement. This article describes a classification system that considers both hard- and soft-tissue defects and the morphology of the extraction socket for immediate implant placement. Recommendations are made concerning the surgical technique required to treat the hard- and soft-tissue defects based on the socket morphology.
Asunto(s)
Carga Inmediata del Implante Dental , Extracción Dental , Alveolo Dental/cirugía , Estética Dental , HumanosRESUMEN
BACKGROUND: Immediate implant placement of dental implants into fresh extraction sockets was shown to be a predictable and successful procedure when proper protocols were followed. Placement into infected sites has been considered a relative contraindication. However, data from animal research, human case reports and case series, and prospective studies showed similar success rates for implants placed into infected sites compared to implants placed in non-infected or pristine sites. The focus questions addressed in this review are: Does the presence of infection compromise the osseointegration of immediate placement of implants? Does the presence of infection compromise immediately placed implant success? What protocols have been used to address the infection prior to immediate implant placement? METHODS: A systematic search of MEDLINE/PubMed articles published from 1982 up to and including November 2009 was independently performed by two investigators (JAW and CIE). The search strategy used combinations of the following terms: dental implants, immediate, immediately, extraction, infection, infected, and pathology. The search included data from animal and human studies. The selection criteria excluded animal studies that did not include a pristine control group and human case reports and case series with <1 year of follow-up. All prospective human studies were included. Studies were limited to those published in the English language, and review article data were excluded. RESULTS: The search strategy initially yielded 417 references. After screening the abstracts for those related to the focus questions, 12 publications qualified for inclusion. The majority of studies examined sites with chronic periapical infection; however, the classification of infection was often vague and not categorized to be related to the outcome. The data from animal studies demonstrated high levels of implant survival, although conflicting data showed that the bone-to-implant contact may be impaired. Human studies showed high levels of implant survival consistent with therapy in non-infected sites, but evidence was limited to a small number of studies and patients. Thorough debridement and the use of systemic antibiotics were employed in all studies. CONCLUSIONS: Evidence suggests implants can be placed into sites with periapical and periodontal infections. The sites must be thoroughly debrided prior to placement. Guided bone regeneration is usually performed to fill the bone-implant gap and/or socket deficiencies. Although controversial, systemic antibiotics should be used until further controlled trials prove otherwise.
Asunto(s)
Infecciones Bacterianas , Implantación Dental Endoósea/métodos , Periodontitis Periapical , Periodontitis , Alveolo Dental/cirugía , Animales , Antibacterianos/uso terapéutico , Desbridamiento , Fracaso de la Restauración Dental , Regeneración Tisular Guiada Periodontal , Humanos , Oseointegración , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: The purpose of this study was to investigate the cumulative survival rates of dental implants placed in a private periodontal practice and the effects of periodontal disease and immediate placement on implant survival. MATERIALS AND METHODS: A retrospective chart review was conducted on 149 consecutive patients. Each patient had a single implant placed. For the purpose of analysis, patients were divided into 2 groups: those who were periodontally healthy and those who had periodontal disease. Implants were placed into available bone either immediately or after a healing period. All failed implants were removed and recorded. The effects of periodontal status and placement time on implant survival were evaluated using Cox proportional hazards regression and log-rank tests. RESULTS: Of the 149 implants in the study, 22 failed during the observation period. The 127 censored cases (i.e., implants that had not failed at the end of the observational period) were observed for a mean of 943 days (SD 932, range 35 to 4,030). Failed implants were observed for a mean of 722 days (SD 1,026, range 18 to 3,548). The presence of periodontal disease appeared to be associated with a greater failure rate, but there was no observed effect associated with time of placement. The percentages of censored immediate placement cases and delayed placement cases were nearly identical. Among the 77 implants associated with periodontal disease, placement time was not strongly associated with percentage censored. Forty-three of the 55 immediately placed implants (78.18%) and 18 of the 22 implants (81.18%) whose placement was delayed were censored. Both Cox proportional hazards regression and log-rank tests established that survival was adversely affected by periodontal disease (P < .05) but unaffected by time of placement (P > .50). The lower 1-sided 95% confidence limit for median survival time was 3,548 days for patients without periodontal disease and 1,799 days for patients with disease. DISCUSSION AND CONCLUSION: Implant survival was compromised by a history of periodontitis but not affected by immediate or delayed placement.