International Journal of Oral Implantology, 03/2022

Peri-implantitis is an infectious disease that leads to progressive bone loss. Surgical therapy has been advocated as a way of halting its progression and re-establishing peri-implant health. One of the most challenging but crucial tasks in the management of peri-implantitis is biofilm removal to achieve reosseointegration and promote the reduction of peri-implant pockets. A wide variety of strategies have been used for implant surface decontamination. Mechanical means have been demonstrated to be effective in eliminating calculus deposits and residual debris; however, the presence of undercuts and the grooves and porosities along the roughened implant surface make it difficult to achieve an aseptic surface. In conjunction with mechanical measures, use of chemical adjuncts has been advocated to dilute bacterial concentrations, destroy the bacteria’s organic components and eliminate endotoxins. Pharmacological adjuncts have also been recommended to diminish the bacterial load. Other strategies, such as use of lasers, implantoplasty and electrolysis, have been suggested for implant surface decontamination to promote predictable clinical and radiographic outcomes. Keywords: dental implant, dental implantation, peri-implant endosseous healing, peri-implantitis Conflict-of-interest statement: The authors declare that they have no direct conflicts of interest. Dr Monje owns royalties to a peri-implantitis kit that includes burs for mechanical detoxi

Purpose: To evaluate the clinical performance of zirconia bars with distal extensions supporting mandibular implant overdentures based on biological and prosthodontic outcomes. Materials and methods: Fifteen edentulous patients (seven women and eight men) were included in a pilot study. Each patient received two interforaminal implants and a mandibular implant overdenture supported by a CAD/CAM zirconia bar with distal extensions, giving a total of 30 implants. The bar design, biological outcomes (implant survival and peri-implant conditions), peri-implant bone level changes recorded on a panoramic radiograph and prosthodontic maintenance (bar fracture and maintenance of the attachment system) were assessed at a 1-year follow-up. Results: After 1 year, all 15 zirconia bars with their corresponding prostheses and implants were successfully in situ with no prosthodontic maintenance required and no biological complications. One patient showed moderate mucosal hyperplasia around the bar. The peri-implant radiographic measurements revealed a stable marginal bone level, with a mean of 0.20 ± 0.67 mm. The mean total length of the bar segments was 41.9 mm (range 35.0 to 51.0 mm), 8.6 mm (range 7.2 to 10.6 mm) of which came from the length of the distal extension, resulting in a mean increase in rigid support of 71% (range 60% to 99%). The mean distal bar connector area was 9.7 mm2 (range 6.8 to 18.7 mm²). Conclusion: Zirconia bars with distal extensions for implant overdentures appear to be a reliable option for the prosthodontic rehabilitation of edentulous mandibles. A survival rate of 100% was observed for implants, bars and prostheses, with stable peri-implant bone levels, no biological complications and a low risk of prosthodontic maintenance being required. Keywords: cohort study, edentulism, implant overdentures, prosthodontic maintenance, zirconia Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study.

The aim of the present study was to generate an international and multidisciplinary consensus on the clinical management of implant protrusion into the maxillary sinuses and nasal fossae. A total of 31 experts participated, 23 of whom were experts in implantology (periodontologists, maxillofacial surgeons and implantologists), 6 were otolaryngologists and 2 were radiologists. All the participants were informed of the current scientific knowledge on the topic based on a systematic search of the literature. A list of statements was created and divided into three surveys: one for all participants, one for implant providers and radiologists and one for otolaryngologists and radiologists. A consensus was reached on 15 out of 17 statements. According to the participants, osseointegrated implants protruding radiographically into the maxillary sinus or nasal fossae require as much monitoring and maintenance as implants fully covered by bone. In the event of symptoms of sinusitis, collaboration between implant providers and otolaryngologists is required. Implant removal should be considered only after pharmacological and surgical management of sinusitis have failed. Keywords: consensus, dental implants, maxillary sinus, nasal fossae Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study.

Purpose: To prove that a fully digital workflow, even for registration of the maxillomandibular relationship, can be employed to produce implant-supported overdentures and demonstrate that CAD/CAM techniques can be used to mill permanent implant-supported overdentures from polymethylmethacrylate discs, using polyetheretherketone as the sliding mechanism. Materials and methods: An edentulous 64-year-old woman received six implants in the maxilla after a bone augmentation procedure and two implants in the mandible. Five months after implant placement, intraoral scans were taken of her original complete dentures, of each prosthesis individually, and of both in centric relation, and another was taken of both edentulous arches, including the scan bodies. Along with facial photographs, sufficient digital data were gathered to design and mill titanium bars, polyetheretherketone female parts and a trial implant-supported overdenture. The tooth positions and colour were discussed with the patient using Smile Design software (3Shape, Copenhagen, Denmark). In the second session, the bars and trial implant-supported overdenture were inserted and checked, and in the third session, the final implant-supported overdentures were inserted. Results: The milled titanium bar exhibited a passive fit, as did the implant-supported overdentures. After 1 year, no prosthetic complications were noted; the measured pockets were all less than 4 mm in depth. On a visual analogue scale from 0 to 10, with 0 being the worst and 10 being the best, the patient awarded a score of 9 for her satisfaction with the implant-supported overdentures. Conclusion: A fully digital workflow enables the production of robust wear-resistant implant-supported overdentures milled from polymethylmethacrylate, using polyetheretherketone female parts as the sliding mechanism, in just three clinical sessions. Keywords: dental prosthesis, digital workflow, implant-supported overdenture Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study.