• Journal of Dental Rehabilitation and Applied Science
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• v.39 no.1
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• pp.32-44
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• 2023

Purpose: The purpose of this study was to investigate the effect of implant connection type on marginal bone loss (MBL) and to analyze the factors that affect MBL. This study focuses on single implants planted in the upper and lower first molar area. Materials and Methods: A total of 87 implants from 68 patients were tracked for a period over 5 years. There were 57 external connection type (EC) implants and 30 internal connection type (IC) implants in 38 males and 30 females. The MBL and EA were measured from intraoral radiograph images taken after 5 years at most. Results: Significant difference in MBL between EC and IC type was observed in patients without GBR or diabetes. Patients without GBR exhibited an MBL of -0.065 ± 0.859 mm in EC type and -0.627 ± 0.639 mm in IC type (P = 0.025). Using multiple regression analysis, a statistically significant negative correlation was observed between MBL and conditions including implant-abutment connection type (β = -0.303), diabetes (β = -0.113), emergence angle > 30° (β = -0.234), and age (β = -0.776). Conclusion: Within this results, IC type implants had less MBL than EC type, and implant prosthesis with emergence angle over 30° showed greater MBL. To minimize the MBL of the implant and ensure implant stability, careful consideration should be given to the EA of implant prosthesis and its connection type.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.5
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• pp.260-266
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• 2019

Objectives: Dental implants shorter than 8 mm, called short dental implants (SDIs), have been considered to have a lower success rate than standard length implants. But recent studies have shown that SDIs have a comparable success rate, and implant diameter was more important for implant survival than implant length. Also, SDIs have many advantages, such as no need for sinus lifting or vertical bone grafting, which may limit use in medically compromised patients. Materials and Methods: In this study, 33 patients with 47 implants 7-mm long were examined over the last four years. All patients had special medical history and were categorized into 3 groups: systemic disorders, such as diabetes mellitus (controlled or uncontrolled), mental disability, and uncontrolled hypertension; oral cancer ablation with reconstruction, with or without radiotherapy; diverse osteomyelitis, such as osteoradionecrosis and bisphosphonate-related osteonecrosis of the jaw. Most of these patients have insufficient residual bone quality due to mandible atrophy or sinus pneumatization. Results: The implant diameters were 4.0 (n=38), 4.5 (n=8), and 5.0 mm (n=1). Among the 47 implants placed, 2 implants failed before the last followup. The survival rate of 7-mm SDIs was 95.74% from stage I surgery to the last follow-up. Survival rates did not differ according to implant diameter. The mean marginal bone loss (MBL) at 3 months, 1 and 2 years was significantly higher than at implant installation, and the MBL at 1 year was also significantly higher than at 3 months. MBL at 1 and 2 years did not differ significantly. Conclusion: Within the limitations of the present study, the results indicate that SDIs provide a reliable treatment, especially for medically compromised patients, to avoid sinus lifting or vertical bone grafting. Further, long-term follow-up is needed.

• Journal of Periodontal and Implant Science
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• v.49 no.1
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• pp.25-38
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• 2019

Purpose: This study evaluated differences in bone healing and remodeling among 3 implants with different surfaces: sandblasting and large-grit acid etching (SLA; IS-III $Active^{(R)}$), SLA with hydroxyapatite nanocoating (IS-III $Bioactive^{(R)}$), and SLA stored in sodium chloride solution ($SLActive^{(R)}$). Methods: The mandibular second, third, and fourth premolars of 9 dogs were extracted. After 4 weeks, 9 dogs with edentulous alveolar ridges underwent surgical placement of 3 implants bilaterally and were allowed to heal for 2, 4, or 12 weeks. Histologic and histomorphometric analyses were performed on 54 stained slides based on the following parameters: vertical marginal bone loss at the buccal and lingual aspects of the implant (b-MBL and l-MBL, respectively), mineralized bone-to-implant contact (mBIC), osteoid-to-implant contact (OIC), total bone-to-implant contact (tBIC), mineralized bone area fraction occupied (mBAFO), osteoid area fraction occupied (OAFO), and total bone area fraction occupied (tBAFO) in the threads of the region of interest. Two-way analysis of variance (3 types of implant $surface{\times}3$ healing time periods) and additional analyses for simple effects were performed. Results: Statistically significant differences were observed across the implant surfaces for OIC, mBIC, tBIC, OAFO, and tBAFO. Statistically significant differences were observed over time for l-MBL, mBIC, tBIC, mBAFO, and tBAFO. In addition, an interaction effect between the implant surface and the healing time period was observed for mBIC, tBIC, and mBAFO. Conclusions: Our results suggest that implant surface wettability facilitates bone healing dynamics, which could be attributed to the improvement of early osseointegration. In addition, osteoblasts might become more activated with the use of HA-coated surface implants than with hydrophobic surface implants in the remodeling phase.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.1
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• pp.13-20
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• 2023

Objectives: Ultra-wide implants may be used as a replacement if existing implants fail. This study was conducted to evaluate the factors influencing the prognosis and failure of ultra-wide implants. Patients and Methods: This study evaluated whether sex, age, site, diameter, length, additional surgery, implant stability (primary and secondary), and reason for ultra-wide implant placement affect the 5-year survival and success rates and marginal bone loss (MBL) of ultra-wide implants. Seventy-eight ultra-wide implants that were placed in 71 patients (39 males and 32 females) from 2008 to 2010 were studied. One-way ANOVA analysis was conducted to evaluate the statistical significance of MBL according to the patient's sex, implant site, and diameter. Independent sample t-tests were used to determine the statistical significance of MBL analysis which was used to determine the significance of the 5-year success and survival rates related to the variables. One-way ANOVA was conducted to evaluate the statistical significance of sex, implantation site, diameter, and MBL. Independent sample t-tests were used to evaluate the correlation between implantability and MBL for implantation reasons, while additional surgery, length, and Kaplan-Meier analysis were used to evaluate 5-year survival and success rates. Results: The mean age of patients was 54.2 years with a survival rate of 92.3% and a success rate of 83.3% over a mean 97.8-month period of observation. MBL averaged 0.2 mm after one year of prosthetic function loading and 0.54 mm at the time of final observation. Success rates correlated with primary stability (P=0.045), survival rates correlated with secondary stability (P=0.036), and MBL did not correlate with any variables. Conclusion: Ultra-wide implants can be used to achieve secure initial fixation in the maxillary and mandibular molar regions with poor bone quality or for alternative purposes in cases of previous implant failure.

• Journal of Periodontal and Implant Science
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• v.45 no.5
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• pp.169-177
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• 2015

Purpose: Despite the high success rates of endosseous dental implants, their placement is restricted according to the height and volume of bone available. The use of short or mini dental implants could be one way to overcome this limitation. Thus, this study aimed to compare standard, short, and mini dental implants with regard to associated clinical parameters and peri-implant crevicular fluid (PICF) levels of cathepsin-K (CTSK), RANK ligand (RANKL), and osteoprotegerin (OPG), after prosthodontic loading. Methods: A total of 78 non-submerged implants (Euroteknika, $Aesthetica^{+2}$, Sallanches, France) were installed in 30 subjects (13 male, 17 female; range, 26-62 years) who visited the clinic of the Periodontology Department, Faculty of Dentistry, Selcuk University. Sampling and measurements were performed on the loading date (baseline) and 2, 14, and 90 days after loading. Assessment of the peri-implant status for the implant sites was performed using the pocket probing depth (PPD), modified plaque index, modified gingival index, modified sulcular bleeding index, and radiographic signs of bone loss. PICF samples collected from each implant were evaluated for CTSK, RANKL, and OPG levels using the ELISA method. Keratinized tissue and marginal bone loss (MBL) were also noted. Results: Clinical parameters statistically significantly increased in each group but did not show statistical differences between groups without PPD. Although implant groups showed a higher MBL in the upper jaw, only the standard dental group demonstrated a statistically significant difference. At 90 days, the OPG:sRANKL ratio and total amounts of CTSK for each group did not differ from baseline. Conclusions: Within the limitations of this study, both short and mini dental implants were achieving the same outcomes as the standard dental implants in the early period after loading.

• Journal of Periodontal and Implant Science
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• v.53 no.2
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• pp.99-109
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• 2023

Purpose: The aim of this systematic review was to evaluate the effectiveness of the socket shield technique (SST), an innovative surgical method introduced in 2010, for reducing buccal bone plate resorption. Methods: The review was conducted following the PRISMA guidelines. Clinical studies conducted in humans and investigating the SST were searched on PubMed (MEDLINE), Embase, Web of Knowledge, and Google Scholar in November and December 2021. The implant survival rate, percentage of complications, and clinical parameters (marginal bone loss [MBL], pink esthetic score [PES], and buccal bone plate resorption [BBPR]) were analyzed using the collected data. Results: The initial search resulted in 132 articles. After article screening, the full texts of 19 studies were read and 17 articles were finally included in the review. In total, 656 implants were installed with the SST. Nine of the 656 implants experienced failure, resulting in an implant survival rate of 98.6%. The percentage of complications was about 3.81%. The analysis of clinical parameters (MBL, PES, and BBPR), showed favorable results for the SST. The mean MBL in implants placed with the SST was 0.39±0.28 mm versus 1.00±0.55 mm in those placed without the SST. PES had a better outcome in the SST group, with an average of 12.08±1.18 versus 10.77±0.74. BBPR had more favorable results in implants placed with the SST (0.32±0.10 mm) than in implants placed with the standard technique (1.05±0.18 mm). Conclusions: The SST could be considered beneficial for preserving the buccal bone plate. However, since only 7 of the included studies were long-term randomized controlled trials comparing the SST with the standard implant placement technique, the conclusions drawn from this systematic review should be interpreted with caution.

• Journal of Dental Rehabilitation and Applied Science
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• v.38 no.2
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• pp.97-109
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• 2022

Purpose: This study aims to investigate the risk indicators contributing to implant failure, and analyze the relationship between risk indicators and marginal bone loss (MBL) through long-term follow-up over 3 years. Materials and Methods: From 2003 to 2017, patients' medical charts with a history of dental implant surgery at Chonnam National University Dental Hospital were reviewed retrospectively. The patient's demographic variables, and clinical variables were recorded. Periapical radiographs were used to evaluated the changes in MBL around implants. And we analyzed implant survival rates. Multiple regression analysis with backward elimination was conducted to correlate the patient's clinical variables and implant failure and Pearson correlation analysis was performed to the correlated between implant long-term survival rates and MBL and initial stability. Results: In multiple regression analysis, there was a statistically significant negative correlation between abutment connection type (β = -.189, P < .05), with or without SPT (β = -.163, P < .05), diabetes (β = -.164, P < .05), osteoporosis (β = -.211, P < .05) and MBL. Anticoagulant medication influenced the long-term success rate of implants. PTV values at the second implant surgery showed a statistically significant negative correlation with long-term implant survival (P < .05). Conclusion: For the long-term success of the implant, the appropriate abutment connection type must be selected and the periodic SPT is recommended. Systemic diseases such as diabetes and osteoporosis and anticoagulant medication should be considered. Furthermore, since high PTV at the second implant surgery correlated with the long-term survival rates of the implant, initial stability should be carefully considered before undergoing the prosthetic procedure.

• Journal of Periodontal and Implant Science
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• v.54 no.2
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• pp.122-135
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• 2024

Purpose: This retrospective study aimed to assess the long-term cumulative survival rate of titanium, sandblasted, large-grit, acid-etched implants over a 10-year follow-up period and investigate the factors affecting the survival rate and change in marginal bone loss (MBL). Methods: The study included 400 patients who underwent dental implant placement at the Department of Periodontology of Seoul National University Dental Hospital (SNUDH) between 2005 and 2015. Panoramic radiographic images and dental records of patients were collected and examined using Kaplan-Meier analysis, Cox proportional hazards regression analysis, and multiple regression analysis to determine the survival rates and identify any factors related to implant failure and MBL. Results: A total of 782 implants were placed with a follow-up period ranging from 0 to 16 years (mean: 8.21±3.75 years). Overall, 25 implants were lost, resulting in a cumulative survival rate of 96.8%. Comparisons of the research variables regarding cumulative survival rate mostly yielded insignificant results. The mean mesial and distal MBLs were 1.85±2.31 mm and 1.59±2.03 mm, respectively. Factors influencing these values included age, diabetes mellitus (DM), jaw location, implant diameter, bone augmentation surgery, and prosthetic unit. Conclusions: This study found that the implant survival rates at SNUDH fell within the acceptable published criteria. The patients' sex, age, DM status, implant location, implant design, implant size, surgical type, bone augmentation, and prosthetic unit had no discernible influence on long-term implant survival. Sandblasted, large-grit, acid-etched implants might offer advantages in terms of implant longevity and consistent clinical outcomes.

• Journal of Periodontal and Implant Science
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• v.52 no.6
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• pp.479-495
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• 2022

Purpose: Rodent models have emerged as an alternative to established larger animal models for peri-implantitis research. However, the construct validity of rodent models is controversial due to a lack of consensus regarding their histological, morphological, and biochemical characteristics. This systematic review sought to validate rodent models by characterizing their morphological changes, particularly marginal bone loss (MBL), a hallmark of peri-implantitis. Methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A literature search was performed electronically using MEDLINE (PubMed), and Embase, identifying pre-clinical studies reporting MBL after experimental peri-implantitis induction in rodents. Each study's risk of bias was assessed using the Systematic Review Center for Laboratory animal Experimentation (SYRCLE) risk of bias tool. A meta-analysis was performed for the difference in MBL, comparing healthy implants to those with experimental peri-implantitis. Results: Of the 1,014 unique records retrieved, 23 studies that met the eligibility criteria were included. Peri-implantitis was induced using 4 methods: ligatures, lipopolysaccharide, microbial infection, and titanium particles. Studies presented high to unclear risks of bias. During the osseointegration phase, 11.6% and 6.4%-11.3% of implants inserted in mice and rats, respectively, had failed to osseointegrate. Twelve studies were included in the meta-analysis of the linear MBL measured using micro-computed tomography. Following experimental peri-implantitis, the MBL was estimated to be 0.25 mm (95% confidence interval [CI], 0.14-0.36 mm) in mice and 0.26 mm (95% CI, 0.19-0.34 mm) in rats. The resulting peri-implant MBL was circumferential, consisting of supra- and infrabony components. Conclusions: Experimental peri-implantitis in rodent models results in circumferential MBL, with morphology consistent with the clinical presentation of peri-implantitis. While rodent models are promising, there is still a need to further characterize their healing potentials, standardize experiment protocols, and improve the reporting of results and methodology.

• Journal of Periodontal and Implant Science
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• v.50 no.2
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• pp.74-82
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• 2020

Purpose: The aim of this cross-sectional study was to investigate the effect of scaling and root planing (SRP) on the expression of anti-inflammatory cytokines (interleukin [IL]-4, IL-9, IL-10, and IL-13) in the gingival crevicular fluid (GCF) of electronic cigarette users and non-smokers with moderate chronic periodontitis (CP). Methods: Electronic cigarette users and non-smokers with CP were included in the study. Full-mouth plaque and gingival indices, probing depth (PD), clinical attachment loss (CAL), and marginal bone loss (MBL) were assessed. The GCF was collected, and its volume and levels of IL-4, IL-9, IL-10, and IL-13 were assessed. These parameters were evaluated at baseline and 3 months after SRP. The sample size was estimated, and comparisons between groups were performed. P<0.05 was considered to indicate statistical significance. Results: Thirty-six electronic cigarette users (47.7±5.8 years old) and 35 non-smokers (46.5±3.4 years old) with CP were included. At baseline, there were no differences in plaque index (PI), PD, CAL, MBL, and GCF IL-4, IL-9, IL-10, and IL-13 between electronic cigarette users and nonsmokers. At the 3-month follow-up, there were no significant differences in PI, gingival index (GI), PD, CAL, and MBL in electronic cigarette users compared to baseline, while there were significant reductions in PI, GI, and PD among non-smokers. At the 3-month follow-up, GCF IL-4, IL-9, IL-10, and IL-13 levels were significantly elevated in both groups (P<0.05) compared to baseline. The increases in GCF IL-4, IL-9, IL-10, and IL-13 levels were significantly higher in non-smokers (P<0.05) than in electronic cigarette users at the 3-month follow-up. Conclusions: Levels of GCF IL-4, IL-9, IL-10, and IL-13 increased after SRP in electronic cigarette users and non-smokers with CP; however, the anti-inflammatory effect of SRP was more profound in non-smokers than in electronic cigarette users.