PubMed · 15675423
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2004. [Tooth replacement 2005].. https://pubmed.ncbi.nlm.nih.gov/15675423/
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BACKGROUND: One of the key factors for the long-term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (perimplantitis) and ultimately to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which are the most effective. OBJECTIVES: To identify the most effective interventions for treating perimplantitis around osseointegrated dental implants. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 15 March 2006. SELECTION CRITERIA: All RCTs of oral implants comparing agents or interventions for treating perimplantitis around dental implants. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. We contacted the authors for missing information. Results were expressed as random-effects models using weighted mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors. MAIN RESULTS: Seven eligible trials were identified, but two were excluded. The following procedures were tested: 1) use of local antibiotics versus ultrasonic debridement; 2) benefits of adjunctive local antibiotics to debridement; 3) different techniques of subgingival debridement; 4) laser versus manual debridement and chlorhexidine irrigation/gel; 5) systemic antibiotics plus resective surgery plus two different local antibiotics with and without implant surface smoothening. Follow up ranged from 3 months to 2 years. No meta-analysis was conducted due to different interventions tested and outcomes used. No side effects occurred in any of the trials. The only significant statistically differences were observed in a 4-month follow-up RCT evaluating the use of adjunctive local antibiotics to manual debridement in patients having lost at least 50% of the supporting bone around the implants. There were improved probing attachment levels (PAL) mean differences of 0.61 mm (95% CI 0.40 to 0.82), and reduced probing pockets depths (PPD) mean differences of 0.59 mm (95% CI 0.39 to 0.79) in those patients receiving adjunctive local antibiotics. This trial was judged to be at high risk of bias. AUTHORS' CONCLUSIONS: There is no reliable evidence suggesting which could be the most effective interventions for treating perimplantitis. This is not to say that currently used interventions are not effective. However, the use of local antibiotics in addition to manual subgingival debridement was associated with a 0.6 mm additional improvement for PAL and PPD over a 4-month period in patients associated with severe forms of perimplantitis. In three trials, the control therapy which basically consisted of a simple subgingival mechanical debridement seemed to be sufficient to achieve results similar to the more complex and expensive therapies. Smoothening of rough implant surfaces was not associated with statistically significant improvements of the clinical outcomes. However, sample sizes were small, therefore these conclusions have to be considered with great caution. More well-designed RCTs are needed.
Ear nose and throat surgeons use endoscopic operations on the sinuses not only for chronic paranasal sinusitis but also for other operations. We report the case of a 52-year-old woman in whom we used an endoscopic technique to remove a dental implant that had been displaced into the maxillary sinus. We approached the sinus through the natural ostium, and the foreign body was removed through the widened ostium.
A recovered dental implant has been studied for surface contamination using SEM and EDS microanalysis. The implant had been in place for 4 years in an adult male (age: 56 years), who had poor oral hygiene and was a smoker. Loosening had occurred, and the implant was removed accidentally during the taking of an impression. Using SEM, three distinct regions were identified, a clear one where the metal appeared shiny and unaffected, a discoloured one, where the surface appeared smooth and uncoated, and a region where there was a distinct deposit. All three regions gave elemental compositions of approximately 85% Ti, 12% Al, 3% V, which is a little richer in aluminium than the nominal overall composition of the usual alloy employed in implants. All three regions showed the presence of carbon, with the highest levels being associated with the surface deposit, and the lowest with the clear region. Oxygen was also present in substantial amounts, with most being found in the discoloured region. No nitrogen was detected, which suggests that the organic surface contamination is not due to interaction with proteins, despite their presence in saliva and crevicular fluid within the mouth.