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Abstract
Discussion Forum (0)
The following report summarises the second paper presented during the Diagnosis and treatment planning in implant dentistry in light of the prevalence of peri-implant diseases session, at the EAO’s 26th annual Scientific Meeting in Madrid, 2017.
Figure 1
The ‘wafer technique’ (Merli et al. 2017) was also described. This technique involves using a thin cortical wall as a boundary, and housing a mixture of particulated autograft and xenograft materials which is then covered by a collagen membrane. This allows us to convert a vertical defect into a (more predictable) horizontal defect. It could be a method for restoring bone defects caused by peri-implantitis (Figures 2–3).
Figure 2
Figure 3
Figure 4
Focus on implant selection, surgical placement and restorative design
Peri-implantitis may be caused and/or exacerbated by a number of iatrogenic factors: residual cement; inadequate seating of the abutment on the implant; implant malposition; a poorly fitting framework; over-contouring of restorations; and technical complications (Lang et al. 2011). This presentation explored the best techniques for addressing peri-implantitis from the very beginning. The speaker argued that the true prevention of peri-implantitis lies in diagnosis and planning, and continues with correct surgically and prosthetically driven treatments, and ends with good long-term supportive care.Implant selection
The use of narrow diameter implants is documented in all regions but only with short-term results (Klein et al. 2014; Ioannidis et al. 2015). In some cases, narrow implants may provide a simple solution (for example, in a thin anterior mandible), provided that the possible mechanical complications are considered. Short implants are supported by clinical evidence (even in the long-term), especially in the posterior mandible (Esposito et al. 2014; Lee et al. 2014; Camps-Font et al. 2016; Tong et al. 2017; Fan et al. 2017; Toti et al. 2017). They can often provide a minimally invasive solution in cases which are less demanding in relation to prosthetics.Surgical placement
Suboptimal treatments may lead ultimately to peri-implantitis, but this can be avoided if the correct treatment steps are followed. This is especially the case with GBR, a predictable technique which allows implant placement in both horizontally and vertically atrophic areas. The long-term stability of augmented bone has been widely proven, and so it should not be assumed that GBR paves the way for further onset of peri-implantitis. On the contrary: if implants are placed without adequate bone volume, peri-implantitis is more likely to occur. Interestingly, in two recent systematic reviews, no differences were observed comparing non-resorbable ePTFE membranes and resorbable collagen membranes (Sanz-Sánchez et al. 2015; Merli et al. 2016). According to the speaker, during the first four-week period three out of four phases of the wound healing process had already occurred. When the collagen membrane was about to disappear, cells were oriented towards bone tissue. Thus, by that point the barrier was no longer necessary. In vertical augmentation, a recent meta-analysis found lower levels of resorption and complications following GBR compared to distraction osteogenesis and block grafting (Clementini et al. 2012; Elnayef et al. 2017). The speaker then described the so-called ‘fence technique’. Space is maintained by a micro-plate (previously prepared in the stereolithographic model) screwed in the mouth and covered by a resorbable collagen membrane. This represents a more conservative approach, since results can be achieved with fewer complications than when a non-resorbable membrane is used (Clementini et al. 2012; Elnayef et al. 2017) (Figure 1).
Restorative design
The prosthesis is the part of the implant where supracrestal tissues are sealed. Over-contouring of the prosthesis (usually caused by implant malposition) disturbs this seal and is an iatrogenic factor leading to mucositis. Often, augmentation procedures are the only way to avoid this.Decision-tree
Finally, the speaker shared an umbrella review which is still in preparation. It is a review of systematic reviews (of RCTs), with the aim of providing guidelines for treating partially edentulous cases with bone defects. The speaker’s proposed decision-tree is outlined in Figure 4.
References
Camps-Font O, Burgueño-Barris G, Figueiredo R, Jung RE, Gay-Escoda, Valmaseda-Castellón E. Interventions for Dental Implant Placement in Atrophic Edentulous Mandibles: Vertical Bone Augmentation and Alternative Treatments. A Meta-Analysis of Randomized Clinical Trials. J Periodontol. 2016 Dec;87(12):1444–1457. Epub 2016 Jul 29. Clementini M, Morlupi A, Canullo L, Agrestini C, Barlattani A. Success rate of dental implants inserted in horizontal and vertical guided bone regenerated areas: a systematic review. Int J Oral Maxillofac Surg. 2012 Jul;41(7):847–52. doi: 10.1016/j.ijom.2012.03.016. Epub 2012 Apr 26. Elnayef B, Monje A, Gargallo-Albiol J, Galindo-Moreno P, Wang HL, Hernández-Alfaro F. Vertical Ridge Augmentation in the Atrophic Mandible: A Systematic Review and Meta-Analysis. Int J Oral Maxillofac Implants. 2017 Mar/Apr;32(2):291–312. doi: 10.11607/jomi.4861. Esposito M, Ardebili Y, Worthington HV. Interventions for replacing missing teeth: different types of dental implants. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD003815. DOI: 10.1002/14651858.CD003815.pub4 Fan T, Li Y, Deng WW, Wu T, Zhang W. Short Implants (5 to 8 mm) Versus Longer Implants (>8 mm) with Sinus Lifting in Atrophic Posterior Maxilla: A Meta-Analysis of RCTs. Clin Implant Dent Relat Res. 2017 Feb;19(1):207–215. doi: 10.1111/cid.12432. Epub 2016 Jun 13. Ioannidis A, Gallucci GO, Jung RE, Borzangy S, Hämmerle CH, Benic GI. Titanium-zirconium narrow-diameter versus titanium regular-diameter implants for anterior and premolar single crowns: 3-year results of a randomized controlled clinical study. J Clin Periodontol. 2015 Nov;42(11):1060–70. Klein MO, Schiegnitz E, Al-Nawas B. Systematic review on success of narrow-diameter dental implants. Int J Oral Maxillofac Implants. 2014;29 Suppl:43–54. doi: 10.11607/jomi.2014suppl.g1.3. Lang NP, Berglundh T; Working Group 4 of Seventh European Workshop on Periodontology. Periimplant diseases: where are we now?--Consensus of the Seventh European Workshop on Periodontology. J Clin Periodontol. 2011 Mar;38 Suppl 11:178–81. doi: 10.1111/j.1600-051X.2010.01674.x. Lee SA, Lee CT, Fu MM, Elmisalati W, Chuang SK. Systematic review and meta-analysis of randomized controlled trials for the management of limited vertical height in the posterior region: short implants (5 to 8 mm) vs longer implants (> 8 mm) in vertically augmented sites. Int J Oral Maxillofac Implants. 2014 Sep–Oct;29(5):1085–97. doi: 10.11607/jomi.3504. Merli M, Merli I, Raffaelli E, Pagliaro U, Nastri L, Nieri M. Bone augmentation at implant dehiscences and fenestrations. A systematic review of randomised controlled trials. Eur J Oral Implantol. 2016 Spring;9(1):11–32. Merli M, Moscatelli M, Mariotti G, Motroni A, Mazzoni A, Mazzoni S, Breschi L, Nieri M. A Novel Approach to Bone Reconstruction: The Wafer Technique. Int J Periodontics Restorative Dent. 2017 May/Jun;37(3):317–325. doi: 10.11607/prd.3055. Sanz-Sánchez I, Ortiz-Vigón A, Sanz-Martín I, Figuero E, Sanz M. Effectiveness of Lateral Bone Augmentation on the Alveolar Crest Dimension: A Systematic Review and Meta-analysis. J Dent Res. 2015 Sep;94(9 Suppl):128S–42S. doi: 10.1177/0022034515594780. Epub 2015 Jul 27. Tong Q, Zhang X, Yu L. Meta-analysis of Randomized Controlled Trials Comparing Clinical Outcomes Between Short Implants and Long Implants with Bone Augmentation Procedure. Int J Oral Maxillofac Implants. 2017 Jan/Feb;32(1):e25–e34. doi: 10.11607/jomi.4793. Epub 2016 Nov 11. Toti P, Marchionni S, Menchini-Fabris GB, Marconcini S, Covani U, Barone A. Surgical techniques used in the rehabilitation of partially edentulous patients with atrophic posterior mandibles: A systematic review and meta-analysis of randomized controlled clinical trials. J Craniomaxillofac Surg. 2017 Aug;45(8):1236–1245. doi: 10.1016/j.jcms.2017.04.011. Epub 2017 Apr 27.EAO Congress Scientific Report; (3), 97–99, 2018.
This summary was prepared by the EAO Congress Scientific Report rapporteurs and approved by the speaker. View the full publication at: www.eao.orgThe following report summarises the second paper presented during the Diagnosis and treatment planning in implant dentistry in light of the prevalence of peri-implant diseases session, at the EAO’s 26th annual Scientific Meeting in Madrid, 2017.
Figure 1
The ‘wafer technique’ (Merli et al. 2017) was also described. This technique involves using a thin cortical wall as a boundary, and housing a mixture of particulated autograft and xenograft materials which is then covered by a collagen membrane. This allows us to convert a vertical defect into a (more predictable) horizontal defect. It could be a method for restoring bone defects caused by peri-implantitis (Figures 2–3).
Figure 2
Figure 3
Figure 4
Focus on implant selection, surgical placement and restorative design
Peri-implantitis may be caused and/or exacerbated by a number of iatrogenic factors: residual cement; inadequate seating of the abutment on the implant; implant malposition; a poorly fitting framework; over-contouring of restorations; and technical complications (Lang et al. 2011). This presentation explored the best techniques for addressing peri-implantitis from the very beginning. The speaker argued that the true prevention of peri-implantitis lies in diagnosis and planning, and continues with correct surgically and prosthetically driven treatments, and ends with good long-term supportive care.Implant selection
The use of narrow diameter implants is documented in all regions but only with short-term results (Klein et al. 2014; Ioannidis et al. 2015). In some cases, narrow implants may provide a simple solution (for example, in a thin anterior mandible), provided that the possible mechanical complications are considered. Short implants are supported by clinical evidence (even in the long-term), especially in the posterior mandible (Esposito et al. 2014; Lee et al. 2014; Camps-Font et al. 2016; Tong et al. 2017; Fan et al. 2017; Toti et al. 2017). They can often provide a minimally invasive solution in cases which are less demanding in relation to prosthetics.Surgical placement
Suboptimal treatments may lead ultimately to peri-implantitis, but this can be avoided if the correct treatment steps are followed. This is especially the case with GBR, a predictable technique which allows implant placement in both horizontally and vertically atrophic areas. The long-term stability of augmented bone has been widely proven, and so it should not be assumed that GBR paves the way for further onset of peri-implantitis. On the contrary: if implants are placed without adequate bone volume, peri-implantitis is more likely to occur. Interestingly, in two recent systematic reviews, no differences were observed comparing non-resorbable ePTFE membranes and resorbable collagen membranes (Sanz-Sánchez et al. 2015; Merli et al. 2016). According to the speaker, during the first four-week period three out of four phases of the wound healing process had already occurred. When the collagen membrane was about to disappear, cells were oriented towards bone tissue. Thus, by that point the barrier was no longer necessary. In vertical augmentation, a recent meta-analysis found lower levels of resorption and complications following GBR compared to distraction osteogenesis and block grafting (Clementini et al. 2012; Elnayef et al. 2017). The speaker then described the so-called ‘fence technique’. Space is maintained by a micro-plate (previously prepared in the stereolithographic model) screwed in the mouth and covered by a resorbable collagen membrane. This represents a more conservative approach, since results can be achieved with fewer complications than when a non-resorbable membrane is used (Clementini et al. 2012; Elnayef et al. 2017) (Figure 1).
Restorative design
The prosthesis is the part of the implant where supracrestal tissues are sealed. Over-contouring of the prosthesis (usually caused by implant malposition) disturbs this seal and is an iatrogenic factor leading to mucositis. Often, augmentation procedures are the only way to avoid this.Decision-tree
Finally, the speaker shared an umbrella review which is still in preparation. It is a review of systematic reviews (of RCTs), with the aim of providing guidelines for treating partially edentulous cases with bone defects. The speaker’s proposed decision-tree is outlined in Figure 4.
References
Camps-Font O, Burgueño-Barris G, Figueiredo R, Jung RE, Gay-Escoda, Valmaseda-Castellón E. Interventions for Dental Implant Placement in Atrophic Edentulous Mandibles: Vertical Bone Augmentation and Alternative Treatments. A Meta-Analysis of Randomized Clinical Trials. J Periodontol. 2016 Dec;87(12):1444–1457. Epub 2016 Jul 29. Clementini M, Morlupi A, Canullo L, Agrestini C, Barlattani A. Success rate of dental implants inserted in horizontal and vertical guided bone regenerated areas: a systematic review. Int J Oral Maxillofac Surg. 2012 Jul;41(7):847–52. doi: 10.1016/j.ijom.2012.03.016. Epub 2012 Apr 26. Elnayef B, Monje A, Gargallo-Albiol J, Galindo-Moreno P, Wang HL, Hernández-Alfaro F. Vertical Ridge Augmentation in the Atrophic Mandible: A Systematic Review and Meta-Analysis. Int J Oral Maxillofac Implants. 2017 Mar/Apr;32(2):291–312. doi: 10.11607/jomi.4861. Esposito M, Ardebili Y, Worthington HV. Interventions for replacing missing teeth: different types of dental implants. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD003815. DOI: 10.1002/14651858.CD003815.pub4 Fan T, Li Y, Deng WW, Wu T, Zhang W. Short Implants (5 to 8 mm) Versus Longer Implants (>8 mm) with Sinus Lifting in Atrophic Posterior Maxilla: A Meta-Analysis of RCTs. Clin Implant Dent Relat Res. 2017 Feb;19(1):207–215. doi: 10.1111/cid.12432. Epub 2016 Jun 13. Ioannidis A, Gallucci GO, Jung RE, Borzangy S, Hämmerle CH, Benic GI. Titanium-zirconium narrow-diameter versus titanium regular-diameter implants for anterior and premolar single crowns: 3-year results of a randomized controlled clinical study. J Clin Periodontol. 2015 Nov;42(11):1060–70. Klein MO, Schiegnitz E, Al-Nawas B. Systematic review on success of narrow-diameter dental implants. Int J Oral Maxillofac Implants. 2014;29 Suppl:43–54. doi: 10.11607/jomi.2014suppl.g1.3. Lang NP, Berglundh T; Working Group 4 of Seventh European Workshop on Periodontology. Periimplant diseases: where are we now?--Consensus of the Seventh European Workshop on Periodontology. J Clin Periodontol. 2011 Mar;38 Suppl 11:178–81. doi: 10.1111/j.1600-051X.2010.01674.x. Lee SA, Lee CT, Fu MM, Elmisalati W, Chuang SK. Systematic review and meta-analysis of randomized controlled trials for the management of limited vertical height in the posterior region: short implants (5 to 8 mm) vs longer implants (> 8 mm) in vertically augmented sites. Int J Oral Maxillofac Implants. 2014 Sep–Oct;29(5):1085–97. doi: 10.11607/jomi.3504. Merli M, Merli I, Raffaelli E, Pagliaro U, Nastri L, Nieri M. Bone augmentation at implant dehiscences and fenestrations. A systematic review of randomised controlled trials. Eur J Oral Implantol. 2016 Spring;9(1):11–32. Merli M, Moscatelli M, Mariotti G, Motroni A, Mazzoni A, Mazzoni S, Breschi L, Nieri M. A Novel Approach to Bone Reconstruction: The Wafer Technique. Int J Periodontics Restorative Dent. 2017 May/Jun;37(3):317–325. doi: 10.11607/prd.3055. Sanz-Sánchez I, Ortiz-Vigón A, Sanz-Martín I, Figuero E, Sanz M. Effectiveness of Lateral Bone Augmentation on the Alveolar Crest Dimension: A Systematic Review and Meta-analysis. J Dent Res. 2015 Sep;94(9 Suppl):128S–42S. doi: 10.1177/0022034515594780. Epub 2015 Jul 27. Tong Q, Zhang X, Yu L. Meta-analysis of Randomized Controlled Trials Comparing Clinical Outcomes Between Short Implants and Long Implants with Bone Augmentation Procedure. Int J Oral Maxillofac Implants. 2017 Jan/Feb;32(1):e25–e34. doi: 10.11607/jomi.4793. Epub 2016 Nov 11. Toti P, Marchionni S, Menchini-Fabris GB, Marconcini S, Covani U, Barone A. Surgical techniques used in the rehabilitation of partially edentulous patients with atrophic posterior mandibles: A systematic review and meta-analysis of randomized controlled clinical trials. J Craniomaxillofac Surg. 2017 Aug;45(8):1236–1245. doi: 10.1016/j.jcms.2017.04.011. Epub 2017 Apr 27.EAO Congress Scientific Report; (3), 97–99, 2018.
This summary was prepared by the EAO Congress Scientific Report rapporteurs and approved by the speaker. View the full publication at: www.eao.orgFocus on implant selection, surgical placement and restorative design
Abstract
Discussion Forum (0)
The following report summarises the second paper presented during the Diagnosis and treatment planning in implant dentistry in light of the prevalence of peri-implant diseases session, at the EAO’s 26th annual Scientific Meeting in Madrid, 2017.
Figure 1
The ‘wafer technique’ (Merli et al. 2017) was also described. This technique involves using a thin cortical wall as a boundary, and housing a mixture of particulated autograft and xenograft materials which is then covered by a collagen membrane. This allows us to convert a vertical defect into a (more predictable) horizontal defect. It could be a method for restoring bone defects caused by peri-implantitis (Figures 2–3).
Figure 2
Figure 3
Figure 4
Focus on implant selection, surgical placement and restorative design
Peri-implantitis may be caused and/or exacerbated by a number of iatrogenic factors: residual cement; inadequate seating of the abutment on the implant; implant malposition; a poorly fitting framework; over-contouring of restorations; and technical complications (Lang et al. 2011). This presentation explored the best techniques for addressing peri-implantitis from the very beginning. The speaker argued that the true prevention of peri-implantitis lies in diagnosis and planning, and continues with correct surgically and prosthetically driven treatments, and ends with good long-term supportive care.Implant selection
The use of narrow diameter implants is documented in all regions but only with short-term results (Klein et al. 2014; Ioannidis et al. 2015). In some cases, narrow implants may provide a simple solution (for example, in a thin anterior mandible), provided that the possible mechanical complications are considered. Short implants are supported by clinical evidence (even in the long-term), especially in the posterior mandible (Esposito et al. 2014; Lee et al. 2014; Camps-Font et al. 2016; Tong et al. 2017; Fan et al. 2017; Toti et al. 2017). They can often provide a minimally invasive solution in cases which are less demanding in relation to prosthetics.Surgical placement
Suboptimal treatments may lead ultimately to peri-implantitis, but this can be avoided if the correct treatment steps are followed. This is especially the case with GBR, a predictable technique which allows implant placement in both horizontally and vertically atrophic areas. The long-term stability of augmented bone has been widely proven, and so it should not be assumed that GBR paves the way for further onset of peri-implantitis. On the contrary: if implants are placed without adequate bone volume, peri-implantitis is more likely to occur. Interestingly, in two recent systematic reviews, no differences were observed comparing non-resorbable ePTFE membranes and resorbable collagen membranes (Sanz-Sánchez et al. 2015; Merli et al. 2016). According to the speaker, during the first four-week period three out of four phases of the wound healing process had already occurred. When the collagen membrane was about to disappear, cells were oriented towards bone tissue. Thus, by that point the barrier was no longer necessary. In vertical augmentation, a recent meta-analysis found lower levels of resorption and complications following GBR compared to distraction osteogenesis and block grafting (Clementini et al. 2012; Elnayef et al. 2017). The speaker then described the so-called ‘fence technique’. Space is maintained by a micro-plate (previously prepared in the stereolithographic model) screwed in the mouth and covered by a resorbable collagen membrane. This represents a more conservative approach, since results can be achieved with fewer complications than when a non-resorbable membrane is used (Clementini et al. 2012; Elnayef et al. 2017) (Figure 1).
Restorative design
The prosthesis is the part of the implant where supracrestal tissues are sealed. Over-contouring of the prosthesis (usually caused by implant malposition) disturbs this seal and is an iatrogenic factor leading to mucositis. Often, augmentation procedures are the only way to avoid this.Decision-tree
Finally, the speaker shared an umbrella review which is still in preparation. It is a review of systematic reviews (of RCTs), with the aim of providing guidelines for treating partially edentulous cases with bone defects. The speaker’s proposed decision-tree is outlined in Figure 4.
References
Camps-Font O, Burgueño-Barris G, Figueiredo R, Jung RE, Gay-Escoda, Valmaseda-Castellón E. Interventions for Dental Implant Placement in Atrophic Edentulous Mandibles: Vertical Bone Augmentation and Alternative Treatments. A Meta-Analysis of Randomized Clinical Trials. J Periodontol. 2016 Dec;87(12):1444–1457. Epub 2016 Jul 29. Clementini M, Morlupi A, Canullo L, Agrestini C, Barlattani A. Success rate of dental implants inserted in horizontal and vertical guided bone regenerated areas: a systematic review. Int J Oral Maxillofac Surg. 2012 Jul;41(7):847–52. doi: 10.1016/j.ijom.2012.03.016. Epub 2012 Apr 26. Elnayef B, Monje A, Gargallo-Albiol J, Galindo-Moreno P, Wang HL, Hernández-Alfaro F. Vertical Ridge Augmentation in the Atrophic Mandible: A Systematic Review and Meta-Analysis. Int J Oral Maxillofac Implants. 2017 Mar/Apr;32(2):291–312. doi: 10.11607/jomi.4861. Esposito M, Ardebili Y, Worthington HV. Interventions for replacing missing teeth: different types of dental implants. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD003815. DOI: 10.1002/14651858.CD003815.pub4 Fan T, Li Y, Deng WW, Wu T, Zhang W. Short Implants (5 to 8 mm) Versus Longer Implants (>8 mm) with Sinus Lifting in Atrophic Posterior Maxilla: A Meta-Analysis of RCTs. Clin Implant Dent Relat Res. 2017 Feb;19(1):207–215. doi: 10.1111/cid.12432. Epub 2016 Jun 13. Ioannidis A, Gallucci GO, Jung RE, Borzangy S, Hämmerle CH, Benic GI. Titanium-zirconium narrow-diameter versus titanium regular-diameter implants for anterior and premolar single crowns: 3-year results of a randomized controlled clinical study. J Clin Periodontol. 2015 Nov;42(11):1060–70. Klein MO, Schiegnitz E, Al-Nawas B. Systematic review on success of narrow-diameter dental implants. Int J Oral Maxillofac Implants. 2014;29 Suppl:43–54. doi: 10.11607/jomi.2014suppl.g1.3. Lang NP, Berglundh T; Working Group 4 of Seventh European Workshop on Periodontology. Periimplant diseases: where are we now?--Consensus of the Seventh European Workshop on Periodontology. J Clin Periodontol. 2011 Mar;38 Suppl 11:178–81. doi: 10.1111/j.1600-051X.2010.01674.x. Lee SA, Lee CT, Fu MM, Elmisalati W, Chuang SK. Systematic review and meta-analysis of randomized controlled trials for the management of limited vertical height in the posterior region: short implants (5 to 8 mm) vs longer implants (> 8 mm) in vertically augmented sites. Int J Oral Maxillofac Implants. 2014 Sep–Oct;29(5):1085–97. doi: 10.11607/jomi.3504. Merli M, Merli I, Raffaelli E, Pagliaro U, Nastri L, Nieri M. Bone augmentation at implant dehiscences and fenestrations. A systematic review of randomised controlled trials. Eur J Oral Implantol. 2016 Spring;9(1):11–32. Merli M, Moscatelli M, Mariotti G, Motroni A, Mazzoni A, Mazzoni S, Breschi L, Nieri M. A Novel Approach to Bone Reconstruction: The Wafer Technique. Int J Periodontics Restorative Dent. 2017 May/Jun;37(3):317–325. doi: 10.11607/prd.3055. Sanz-Sánchez I, Ortiz-Vigón A, Sanz-Martín I, Figuero E, Sanz M. Effectiveness of Lateral Bone Augmentation on the Alveolar Crest Dimension: A Systematic Review and Meta-analysis. J Dent Res. 2015 Sep;94(9 Suppl):128S–42S. doi: 10.1177/0022034515594780. Epub 2015 Jul 27. Tong Q, Zhang X, Yu L. Meta-analysis of Randomized Controlled Trials Comparing Clinical Outcomes Between Short Implants and Long Implants with Bone Augmentation Procedure. Int J Oral Maxillofac Implants. 2017 Jan/Feb;32(1):e25–e34. doi: 10.11607/jomi.4793. Epub 2016 Nov 11. Toti P, Marchionni S, Menchini-Fabris GB, Marconcini S, Covani U, Barone A. Surgical techniques used in the rehabilitation of partially edentulous patients with atrophic posterior mandibles: A systematic review and meta-analysis of randomized controlled clinical trials. J Craniomaxillofac Surg. 2017 Aug;45(8):1236–1245. doi: 10.1016/j.jcms.2017.04.011. Epub 2017 Apr 27.EAO Congress Scientific Report; (3), 97–99, 2018.
This summary was prepared by the EAO Congress Scientific Report rapporteurs and approved by the speaker. View the full publication at: www.eao.orgThe following report summarises the second paper presented during the Diagnosis and treatment planning in implant dentistry in light of the prevalence of peri-implant diseases session, at the EAO’s 26th annual Scientific Meeting in Madrid, 2017.
Figure 1
The ‘wafer technique’ (Merli et al. 2017) was also described. This technique involves using a thin cortical wall as a boundary, and housing a mixture of particulated autograft and xenograft materials which is then covered by a collagen membrane. This allows us to convert a vertical defect into a (more predictable) horizontal defect. It could be a method for restoring bone defects caused by peri-implantitis (Figures 2–3).
Figure 2
Figure 3
Figure 4
Focus on implant selection, surgical placement and restorative design
Peri-implantitis may be caused and/or exacerbated by a number of iatrogenic factors: residual cement; inadequate seating of the abutment on the implant; implant malposition; a poorly fitting framework; over-contouring of restorations; and technical complications (Lang et al. 2011). This presentation explored the best techniques for addressing peri-implantitis from the very beginning. The speaker argued that the true prevention of peri-implantitis lies in diagnosis and planning, and continues with correct surgically and prosthetically driven treatments, and ends with good long-term supportive care.Implant selection
The use of narrow diameter implants is documented in all regions but only with short-term results (Klein et al. 2014; Ioannidis et al. 2015). In some cases, narrow implants may provide a simple solution (for example, in a thin anterior mandible), provided that the possible mechanical complications are considered. Short implants are supported by clinical evidence (even in the long-term), especially in the posterior mandible (Esposito et al. 2014; Lee et al. 2014; Camps-Font et al. 2016; Tong et al. 2017; Fan et al. 2017; Toti et al. 2017). They can often provide a minimally invasive solution in cases which are less demanding in relation to prosthetics.Surgical placement
Suboptimal treatments may lead ultimately to peri-implantitis, but this can be avoided if the correct treatment steps are followed. This is especially the case with GBR, a predictable technique which allows implant placement in both horizontally and vertically atrophic areas. The long-term stability of augmented bone has been widely proven, and so it should not be assumed that GBR paves the way for further onset of peri-implantitis. On the contrary: if implants are placed without adequate bone volume, peri-implantitis is more likely to occur. Interestingly, in two recent systematic reviews, no differences were observed comparing non-resorbable ePTFE membranes and resorbable collagen membranes (Sanz-Sánchez et al. 2015; Merli et al. 2016). According to the speaker, during the first four-week period three out of four phases of the wound healing process had already occurred. When the collagen membrane was about to disappear, cells were oriented towards bone tissue. Thus, by that point the barrier was no longer necessary. In vertical augmentation, a recent meta-analysis found lower levels of resorption and complications following GBR compared to distraction osteogenesis and block grafting (Clementini et al. 2012; Elnayef et al. 2017). The speaker then described the so-called ‘fence technique’. Space is maintained by a micro-plate (previously prepared in the stereolithographic model) screwed in the mouth and covered by a resorbable collagen membrane. This represents a more conservative approach, since results can be achieved with fewer complications than when a non-resorbable membrane is used (Clementini et al. 2012; Elnayef et al. 2017) (Figure 1).
Restorative design
The prosthesis is the part of the implant where supracrestal tissues are sealed. Over-contouring of the prosthesis (usually caused by implant malposition) disturbs this seal and is an iatrogenic factor leading to mucositis. Often, augmentation procedures are the only way to avoid this.Decision-tree
Finally, the speaker shared an umbrella review which is still in preparation. It is a review of systematic reviews (of RCTs), with the aim of providing guidelines for treating partially edentulous cases with bone defects. The speaker’s proposed decision-tree is outlined in Figure 4.
References
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This summary was prepared by the EAO Congress Scientific Report rapporteurs and approved by the speaker. View the full publication at: www.eao.org{{ help_message }}
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