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JADA Specialty Scan - Radiology
A Quarterly Newsletter on Dental SpecialtiesJADA Specialty Scan

Does osteoporosis influence the marginal peri-implant bone level in female patients?

No contraindication exists for placing dental implants in osteoporotic patients, although osteoporosis greatly influences peri-implant bone remodeling. The findings are from a study published online in the August issue of Clinical Implant Dentistry Related Research.

Researchers designed the study to investigate the role of osteoporosis in the marginal peri-implant bone level. Patients included in the study were postmenopausal women with at least 1 dental implant in situ for at least 1 year.

The authors used a printed questionnaire to assess osteoporosis/osteopenia, incidence of fragility fractures, smoking habits, thyroid disorder, diabetes, and medication. Researchers categorized implants as machined, moderately rough, and rough, based on the surface roughness.

The authors evaluated peri-implant marginal bone loss (MBL) at 3 different times: at the time of implant placement (baseline), 1 year after implant placement, and in the most recent orthopantomogram. MBL was assessed mesial and distal to each implant. Researchers measured bone level changes as the vertical distance between implant abutment interface and implant apex. Marginal bone level-to-implant apex was assessed at the time of follow-up visits and compared with baseline evaluation; the distance between baseline and follow-up was considered as peri-implant bone loss per site. To obtain the actual bone loss in millimeters, the dimensional distortion was corrected by the ratio between the apparent implant-dimension and the actual implant size.

Researchers analyzed 48 women with a total of 204 implants, who they divided into 2 groups: healthy patients (control) and patients with osteoporosis and dental implants (test). Seven patients had a diagnosis of osteoporosis before implant placement, 4 at the time of implant placement, and 7 after implant placement.

Of the 48 women, 30 were healthy and 18 had a diagnosis of osteoporosis. The mean mesial MBL—statistically corrected to report the first year—was 20.661.2 mm (range, 25.1-2.2) in the control group and 21.161.3 mm (range, 25.3-2.2) in the test group. The mean distal MBL was 20.561.3 mm (range, 25.1-4.8) in the control group and 21.261.3 mm (range, 24.7-1.6) in the test group.

Researchers found significant effects of bone level at time of implant placement, jaw, rough versus moderate surface, augmentation, vitamin D intake, and internal tripod connection type at the mesial and distal implant aspects. Fixed prosthodontics had a significant influence only at the mesial implant aspect whereas internal hex connection type had a significant influence only at the distal implant aspect. The factors implant position (anterior versus posterior), machined versus moderate implant surface, presence of cement, presence of plaque, edentulous opposing jaw, edentulous implant jaw, and bisphosphonates did not have significant effects on the MBL at the mesial and distal implant aspects.

“Due to the relevance of the bone level at the time of implant placement,” the authors observed, “this study implicates to respect the bone level and not to place the implant below bone level if possible.”

Read the original article here.


Consulting Editor: Clark M. Stanford, DDS, PhDS
Distinguished Professor and Dean
University of Illinois at Chicago College of Dentistry
Treasurer, Academy of Osseointegration Board of Directors


Medical and pharmacological histories are key factors before dental implant placement

Extending the scope of a medical questionnaire to include past chronic diseases and medications in addition to the patient’s current medical status is crucial when diagnosing bisphosphonate-related osteonecrosis of the jaw (BRONJ), especially before elective dental implant placement. This conclusion is from a study published online Aug. 26, 2012, in the Australian Dental Journal.

The authors present a case study of a 73-year-old woman referred by her prosthodontist after exposed bone was observed in the left maxilla. Her medical history included rheumatoid arthritis, chronic obstructive pulmonary disease, gastroesophageal reflux disease, hyperlipidaemia, bilateral cataracts, osteoporosis, and heavy smoking (up to 30 cigarettes per day for more than 50 years). Her medications included prednisone, albuterol inhalations, omeprazole, simvastatin, hydroxyl ethylcellulose 0.4% eye drops, lanolin oil 3% ophthalmic ointment, calcium, and vitamin D.

Her dental history included the placement of 4 dental implants in the maxillary arch and 3 implants in the anterior mandibular arch. Fixed maxillary and removal mandibular prostheses were placed 8 months after implant surgery. An examination revealed an area of exposed necrotic bone with purulent drainage and debris around the posterior maxillary left implant. The necrotic bone was sensitive to light palpation and immobile as it was splinted by the implant-supported bridge.

The medical history was revisited based on the clinical presentation. The medical file revealed that the patient took oral alendronate sodium for about 4.5 years, which was stopped 2 years before implant placement. There was no history of therapeutic radiation to the head and neck area or administration of other medications known to cause osteonecrosis (that is, bevacizumab or sunitinib). The treating dentist was unaware of the history of bisphosphonate use before implant placement. BRONJ was diagnosed based on the new information and because the existing lesion was confirmed to be more than 2 months old.

The treatment plan included local antiseptic mouthwash, antibiotics, removal of the involved implant, and surgical debridement of the necrotic bone. After the bridge was sectioned, the necrotic bone was mobile and removed without the need for further surgery.

The authors noted a 3-fold challenge with obtaining an accurate history of bisphosphonate administration:

  • (1) Bisphosphonates are administered using various dosing protocols and administration routes, such that the patient may not consider them as part of their ‘regular/daily’ medications;
  • (2) patients may not consider it important to mention they have osteoporosis;
  • (3) patients do not understand the implications/importance of medications (current and past) to their dental treatment. The details of the accumulated doses are also important.

“Considering the relationship between bisphosphonate levels and the risk of BRONJ development,” the authors concluded, “the precise details of the dosing protocols, such as frequency and duration, should be determined.”

Read the original article here.


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Periodontal disease and smoking as risk factors for peri-implantitis: a systematic review

Limited evidence exists to suggest that history of periodontitis is a possible risk factor for peri-implantitis, while insufficient data exist to assess the role of smoking as a risk factor for implant loss and per-implantitis. These conclusions are from a study published online in the July-September  2016 Journal of Oral & Maxillofacial Research.

The authors conducted the systematic review to assess scientific evidence regarding the history of periodontitis and smoking habits as risk factors for implant loss and incidence of peri-implantitis.

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines and was registered at the PROSPERO database (registration CRD42016034160 [effect of history of periodontitis] and CRD42016033676 [effect of smoking]). A broad MEDLINE and manual search of articles published from Jan. 1, 1990, through Dec. 31, 2015, yielded 49,332 records for history of periodontitis and 3,199 for smoking habits. Selection criteria included prospective studies comparing 2 cohorts of patients with and without the investigated risk factor with a minimum follow-up period of 3 years, as well as reporting data on peri-implantitis and implant loss occurrence.

Participants analyzed in the included studies had to have had at least 1 osseointegrated titanium screw-shaped dental implant followed for at least 3 years. Researchers eliminated 49,312 articles and examined 20 full-text articles to assess their eligibility. They chose 3 studies evaluating the history of periodontitis and 1 study on the effect of smoking. The median year of publication was 2008.

Implant- and patient-based meta-analyses revealed a significantly higher risk of developing peri-implantitis in patients with a history of periodontitis than in participants who did not, but there was not a statistically significant increased risk of experiencing implant loss.

Two studies showed a higher and statistically significant implant loss rate in patients with a history of periodontitis both on an implant and patient level. In the third study, the implant loss rate (on an implant level; patient level data were not reported) was greater in patients with periodontitis than in patients who did not, but without reaching a statistical significance.

The overall risk ratio (RR) was 0.37 (0.10-1.38) in favor of patients without periodontitis; the overall effect was not significant (P = .14). For the occurrence of peri-implantitis (considering the implant as the statistical unit), the overall RR was 0.23 (0.11-0.46) in favor of patients without periodontitis; the overall effect was significant (P < .0001). For the implant loss (considering the patient as the statistical unit), the overall RR was 0.32 (0.04-2.69) in favor of the patients without periodontitis; the overall effect was not significant (P = .29). For the occurrence of peri-implantitis (considering the patient as the statistical unit), the overall RR was 0.25 (0.07-0.88) in favor of the periodontally healthy patients; the overall effect was significant (P = .003).

Read the original article here.


How altering the salivary microbiome affects marginal bone loss near a nonsubmerged implant

Smoking shapes the salivary microbiome in states of clinical health and may interfere the marginal bone loss (MBL) during bone healing by creating high-at-risk-for-harm communities. These conclusions are from a study published online Aug. 28, 2017 in the Journal of Periodontology.

Researchers designed the study to test the hypothesis that a smoking habit can lead to significant changes in structure and composition of the salivary microbiome and further affect the MBL around an implant during bone healing.

They examined 20 systemically healthy participants with single-tooth replacement in the posterior mandible where bone density was evaluated as normal (types II and III). The patients were divided into 2 groups: smokers, those who smoked more than 10 cigarettes per day for at least 5 years (n = 10); and nonsmokers, those who never smoked (n = 10).

Number of remaining teeth, full-mouth plaque index (PI), full-mouth gingival index (GI), and probing depth (PD, in millimeters) were measured preoperatively. PI and GI were measured at 4 sites per tooth (mesiobuccal, buccal, distobuccal and lingual). PD was measured at 6 sites per teeth (mesiobuccal, buccal, distobuccal, distolingual, lingual and mesiolingual) by using a standard periodontal probe. Likewise, peri-implant PD and bleeding on probing were measured by 1 blinded investigator. The K (Kappa) score for intraexaminer reliability was 0.94.

Before surgery, researchers collected 5 milliliters of spontaneous, whole unstimulated saliva in a sterile DNA-free conical tube from each participant between 8 a.m. and 9 a.m. Participants were instructed to refrain from drinking and eating for at least 2 hours before sampling and from performing oral hygiene (that is, brushing or flossing teeth) for 12 hours before sampling. All samples were stored at −80°C before further processing.

Ten nonsmokers and 10 smokers (11 men and 9 women; age range, 29 to 60 years) were recruited for this study,. Smokers showed significantly greater MBL during bone loss compared with nonsmokers (P = .003). There were no significant differences between smokers and nonsmokers for other clinical characteristics or demographics (P > .05).

The authors compared 871,389 sequences against the Human Oral Microbiome Database (HOMD) for bacterial identification. Microbial signatures of smokers exhibited lower diversity and richness, with a significant decreased in uncultured species. The phyla Gracilibacteria and Saccharibacteria showed a significantly decrease in smokers. The genera Streptococcus, Lachnoanaerobaculum, Stomatobaculum, and Eubacterium were significantly increased in smokers, while Selenomonas, Selenomonas [G-3,] and Catonella were significantly decreased. Specifically, Porphyromonas gingivalis was significantly more abundant in smokers, which was positively related with the severity of MBL during bone healing.

“Understanding of the distinctly divergent oral microbiome in smokers and nonsmokers is a base for personalized therapeutics for this high-risk cohort,” the authors concluded, “and also a base for further study on the pathological mechanisms.”

Read the original article here.


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Save the date: AO plans annual meeting for February 28 – March 3, 2018

The Academy of Osseointegration’s Annual Meeting, “Inspiring Imagination — Enhancing Health,” is planned for February 28-March 3, 2018. For the first time in its history, AO will host its four-day scientific conference in the heart of vibrant downtown Los Angeles, California, AO’s 2018 Annual Meeting is expected to attract more than 2,000 specialists, general practitioners, lab technicians, allied staff, and other health care professionals. This international event will offer:

  • The opportunity to earn more than 30 hours of ADA CERP Credit via continuing education programs, including in-depth hands-on workshops and presentations from the main podium by AO’s lineup of world-renowned speakers.
  • Global networking opportunities for attendees to collaborate with their peers across all specialties to gain practical takeaways that can be quickly implemented, discuss best practices, and discover new solutions for common challenges.

  • AO’s President’s Reception, one of the meeting’s most popular social events.

Registration for AO’s 2018 will open later this fall, but a preview is available via our website.


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JADA+ Specialty Scans and JADA+ Scans

JADA+ Specialty Scans and JADA+ Scans are quarterly newsletters updating dentists on the latest research in selected specialties and disciplines in dentistry. ADA Publishing and the consulting editors from the represented specialties and disciplines aggregate and summarize research from previously published materials, each item attributed to its publication of origin. JADA+ Scan specialties and disciplines include endodontics, oral pathology, orthodontics, pediatric dentistry, periodontics, prosthodontics, radiology, cosmetic/esthetic and osseointegration. The ADA has engaged the specialty organizations in these areas as well as its own Science Institute and Division of Legal Affairs to assist with these newsletters. View past issues here.

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