BACKGROUND:Peri-implantitis is a biofilm-induced inflammatory disease that jeopardizes dental implant longevity and human health. As an infectious disease, its incomplete resolution with mechanical debridement alone necessitates adjunctive approaches. Systemic probiotics, within modern medicine, offer antimicrobial and immunomodulatory benefits that may enhance peri-implant health and oral wellbeing, with relevance to broader public health. AIM:To evaluate the clinical and microbiological efficacy of systemic probiotic supplementation as an adjunct to mechanical debridement in the treatment of peri-implantitis. METHODS:This prospective clinical study included 50 systemically healthy patients diagnosed with peri-implantitis. Participants were randomly assigned into two groups: Group 1 (n = 25) received mechanical debridement with placebo, while Group 2 (n = 25) received mechanical debridement combined with systemic probiotic supplementation for 30 days. Clinical parameters including Plaque Index (PI), Gingival Index (GI), probing pocket depth (PPD), clinical attachment level (CAL), and microbial load (CFU/mL) were evaluated at baseline and after one month. RESULTS:Both groups showed significant improvements from baseline to one month (p < 0.05); however, Group 2 demonstrated superior outcomes. At one month, Group 2 showed lower PI (0.48 ± 0.22), GI (0.52 ± 0.09), PPD (2.78 ± 0.11 mm), CAL (3.02 ± 0.07 mm), and microbial load (0.49 ± 0.02 ȕ 103 CFU/mL) compared to Group 1 (p = 0.00 for all parameters). CONCLUSION:Systemic probiotics, when used as an adjunct to mechanical debridement, significantly improve clinical and microbiological outcomes in peri-implantitis management. This combination may offer a synergistic approach for enhanced therapeutic efficacy.
This study explores the application of artificial intelligence (AI) and deep learning models, specifically convolutional neural networks (CNNs), to identify dental implant brands using orthopantomogram (OPG) images. Dental implants are crucial in modern dentistry for replacing missing teeth, and accurate identification of implant brands is essential for effective treatment and long-term patient care. Traditional methods of implant identification rely on manual comparison with reference libraries and visual assessment, which are often time-consuming and prone to errors due to the increasing variety of implant brands. AI offers a promising alternative by automating the detection process, thereby improving accuracy and reducing the reliance on human expertise. The study highlights the importance of preprocessing OPG images through techniques such as contrast enhancement and noise reduction to improve the visibility of critical implant features. It also discusses the role of image segmentation in isolating implants from surrounding anatomical structures, which is crucial for accurate analysis. Feature extraction, another key step, involves identifying and isolating unique implant characteristics that distinguish different brands. The integration of AI in clinical practice offers significant advantages, including faster and more reliable implant identification, which can enhance treatment planning and patient outcomes. However, the study also acknowledges the challenges associated with AI, such as the need for large, well-annotated datasets and the ethical concerns related to data privacy and the interpretability of AI models. The research concludes by emphasizing the potential of AI to revolutionize implantology, particularly as AI technologies continue to advance and become more integrated into clinical workflows.
BACKGROUND:Vitamin D plays a pivotal role in bone metabolism and immune regulation, both of which are fundamental to peri-implant health and overall human wellbeing. Postmenopausal women are particularly susceptible to vitamin D deficiency due to hormonal alterations, a condition that may predispose them to peri-implant disease and compromise implant success. Addressing this deficiency through evidence-based medicine has important implications for maintaining oral health and mitigating broader public health concerns related to implant failure. AIM:To evaluate and compare the correlation between serum 25-hydroxyvitamin D [25(OH)D] levels and peri-implant clinical and radiographic parameters among premenopausal and postmenopausal women. METHODS:This cross-sectional study included 180 female patients with functional dental implants placed at least 12 months prior to recruitment. Group I consisted of 90 premenopausal women, while Group II included 90 postmenopausal women. Peri-implant probing depth (PPD) and crestal bone level (CBL) were assessed clinically and radiographically. Serum 25(OH)D levels were measured using electrochemiluminescence immunoassay. Data were analyzed using unpaired t-tests and Pearson correlation. RESULTS:Postmenopausal women exhibited significantly lower serum 25(OH)D levels (18.0 ± 0.6 ng/mL) compared to premenopausal women (34.5 ± 0.8 ng/mL), along with greater PPD and CBL (p < 0.05). A significant moderate negative correlation was found between serum 25(OH)D and both PPD and CBL in both groups, stronger in postmenopausal women (r = -0.64 for PPD, -0.47 for CBL). CONCLUSION:Vitamin D deficiency is associated with increased peri-implant probing depth and crestal bone loss, particularly in postmenopausal women. Screening and correcting vitamin D levels may enhance implant outcomes in this population.
Purpose of this study was to evaluate the distribution of bone tension around single implants with different С/I ratio (1.5:1, 1.75:1, 2:1) according to the von Mises criterion. Stress analysis was performed using Invesalius 3.0, Rhinoceros 3D 4.0 software. Three 3D models of the mandibular segment of the bone block were developed: model A, a short implant (6 mm) C/I -1.5:1; model B, a short implant (6 mm) C/I -1.75:1; model C, a short implant (6 mm) C/I -2:1. The results were evaluated: the cumulative frequency of implant engraftment, MBL changes around the implant, follow up for 5 years. Under axial load, the highest stresses were concentrated at the abutment/implant junctions, the highest stresses were 67.94 MPa C/I -1.5:1, 68.09 MPa C/I -1.75:1 and 68.24 MPa C/ I -2:1, respectively. The results of the current study, indicate the increase in crown height showed little difference in load at the crown/implant interface with crown/implant ratios of 1.5:1, 1.75:1 and 2:1. In vivo finite element analysis (FEA) study showed that short implantats are successful regardless the C/I ratio. Use of shorts implants for prosthetic rehabilitation can be considered favorable and well substantiated.
Peri-implant diseases such as peri-implant mucositis and peri-implantitis adversely affect human health and oral wellbeing, posing a notable public health challenge, particularly in patients with a history of generalized chronic periodontitis. These biofilm-mediated inflammatory conditions represent an infectious disease process that can progress to peri-implant disease and functional illness if not managed appropriately. Early identification and timely intervention, guided by principles of preventive medicine, during the post-restorative maintenance phase are essential for long-term implant success. This cross-sectional study aimed to evaluate the prevalence of peri-implant mucositis and peri-implantitis one year after prosthetic loading in patients with previously treated generalized chronic periodontitis, maintained on regular supportive periodontal therapy (SPT). The study included patients aged 30-60 years with a history of generalized chronic periodontitis who had undergone full-mouth periodontal flap surgery and were compliant with SPT for at least one-year post-implant prosthetic loading. Peri-implant conditions were diagnosed according to the 2017 AAP/EFP classification criteria. Data from 403 patients and 679 implants were analyzed using SPSS 23.0 to determine prevalence rates at both patient and implant levels. Among 403 patients (44.9% female, 55.1% male), 55.6% exhibited peri-implant health, 28.5% had peri-implant mucositis, and 15.9% showed peri-implantitis. At the implant level, 73.8% of the 679 implants were healthy, while 15.2% had mucositis and 11.0% had peri-implantitis. In a high-risk population with a history of generalized chronic periodontitis and adherence to supportive periodontal therapy, peri-implant mucositis and peri-implantitis were prevalent one-year post-loading. These findings underscore the importance of rigorous monitoring and tailored maintenance protocols to prevent peri-implant disease progression in susceptible patients.
INTRODUCTION:Oral implants are a reliable and effective solution for replacing missing teeth. The surface topography of dental implants is essential for osseointegration, a critical factor for long-term success. Both macroscopic and microscopic features of the implant surface contribute significantly to achieving and maintaining osseointegration. Surface topography is especially important for the bone-tissue response to a dental implant, particularly during unloaded conditions. This factor enhances osseointegration in compromised bone conditions, where an oxidized surface can improve coagulum stability, facilitating bone healing on the implant surface. MATERIALS AND METHODS:Forty titanium alloy implants of a commercially available design, each 4 mm in diameter and 8 mm in length, were used. The implants were divided into two groups: 20 control implants with machined surfaces and 20 test implants treated with SLA. All implants had a similar thread design (Buttress, IFIX, India). The first part of the study assessed surface roughness using scanning electron microscopy (SEM) and evaluated surface topography with a 3D optical profilometer using white light laser. The second part investigated the early bone response and biological reaction to the modified implant surface using Netherland lop-eared rabbits. Test and control implants were placed contra laterally in the left and right hind legs of the rabbits, both in the proximal tibia and distal femur condyle. All implants were retrieved en bloc with the surrounding bone, fixed in 4% buffered formaldehyde, and subjected to histomorphometric analysis. CONCLUSION:SLA-treated titanium alloy implants showed greater bone volume and bone-to-implant contact compared to machined surface implants.
Following the extraction of a tooth, the alveolar bone undergoes resorption, impacting the remaining bone volume. This phenomenon is particularly pronounced in the posterior upper jaw region, where the bone surrounding the extraction site undergoes physiological transformation, and potential pneumatization of the maxillary sinus. Consequently, there is a reduction in available bone volume and height. Various methods have been described in literature to address this issue. Two main scientifically based techniques for sinus lift are extensively studied and established today, each suitable for specific clinical scenario primarily determined by the residual bone height. The Tatum (direct) approach is recommended when there is less than 5 mm of remaining bone, while the Summer (indirect) technique is preferred when there is more than 5 mm of residual bone. This case report presents a novel technique that integrates the core principle of the above procedures, aiming to simplify indirect sinus lifts in situations that were previously considered challenging owing to inadequate bone volume. A patient with a 2 mm residual maxillary sinus floor height was selected for this case report. A flapless graft-free intracrestal approach was performed in two steps as follows: (1) a tissue-punch is used to harvest the soft tissue from the crest where the implant is to be placed, the graft is then relocated and placed buccal to the same site; (2) a circular knife is used at the exposed bone to cut an opening/bone window which allows performing the intra-crestal displacement of the Schneiderian membrane using curette and placing a dental implant through the same opening/implant bed. A six-month post-operative peri-apical radiograph and CBCT scan showed 4-5 mm extra height of newly formed bone around the implant in the lifted sinus. Also, CBCT scans after five years confirmed the stability, quality, and quantity of the newly formed bone. This novel approach of minimally invasive "flapless" intra-crestal sinus lifting, simultaneously with implant placement, may be effective in conducting bone formation in certain clinical conditions, where residual bone height is equal or less than 3 mm, even without utilizing bone substitute materials.
Peri-implantitis is a biofilm-induced inflammatory disease that compromises peri-implant tissues, adversely affecting human health and implant survival. As an infectious disease, its management through mechanical debridement alone is often limited by persistent microbial burden. Adjunctive probiotic therapy, grounded in contemporary medicine, has therefore been proposed to improve peri-implant health and oral wellbeing, with potential relevance to broader public health outcomes. The aim of the study was to evaluate the clinical and microbiological effects of subgingival probiotic delivery as an adjunct to mechanical debridement in the non-surgical management of peri-implantitis. A prospective clinical study was conducted involving 52 systemically and periodontally healthy individuals aged 30-60 years with peri-implantitis. Participants were randomly divided into two groups (n = 26 each). Group 1 received mechanical debridement alone, while Group 2 received mechanical debridement combined with subgingival application of Lactobacillus reuteri probiotic. Clinical parameters (PI, GI, PPD, and CAL) and Porphyromonas gingivalis levels were assessed at baseline and three months. RT-PCR was used for microbiological evaluation. Data were analyzed using paired and independent t-tests, with P < 0.05 considered significant. Both groups showed significant intra-group improvements in clinical and microbiological parameters (P < 0.05). However, Group 2 exhibited significantly greater reductions in PI, GI, PPD, CAL, and P. gingivalis levels compared with Group 1 (P = 0.00), demonstrating the superior effectiveness of probiotic therapy. Adjunctive probiotic therapy significantly improves clinical outcomes and reduces microbial load in peri-implantitis patients, offering a beneficial addition to mechanical debridement.
The purpose of this study was to compare outcomes following open reduction and internal fixation (ORIF) of proximal humerus fractures with Zimmer Biomet and DePuy Synthes plating systems. This was a retrospective review of patients who underwent proximal humerus fracture fixation utilizing Zimmer Biomet or DePuy Synthes plating systems between June 2016 and February 2023. Patients without postoperative follow-up were excluded. Complication rates were compared between the two cohorts using chi-square and two-tailed t-tests for categorical and continuous variables, respectively. A total of 86 patients were identified for inclusion and eight were excluded for inadequate follow up. Statistical analysis comprised a total of 78 patients, 41 who underwent ORIF with a Zimmer Biomet implant, and 37 who underwent ORIF with a DePuy Synthes implant. The overall complication rate was 4.88% (n = 2) in the Zimmer Biomet cohort and 13.5% (n = 5) in the DePuy Synthes cohort (P > 0.05). Both Zimmer Biomet patients required revision surgery, compared with two out of five patients in the DePuy-Synthes group. There were no statistically significant differences in rates of avascular necrosis, impingement, malunion, or fixation failure between the two cohorts. Overall complication rate and need for revision surgery were similar between patients who underwent fixation with the Zimmer Biomet or DePuy Synthes plating systems. Our findings support selection of either plating system based on surgeon preference and equipment availability as neither demonstrated clinical superiority.
