A pilot study of a deep learning approach to detect marginal bone loss around implants

Background Recently, there has been considerable innovation in artificial intelligence (AI) for healthcare. Convolutional neural networks (CNNs) show excellent object detection and classification performance. This study assessed the accuracy of an artificial intelligence (AI) application for the detection of marginal bone loss on periapical radiographs. Methods A Faster region-based convolutional neural network (R-CNN) was trained. Overall, 1670 periapical radiographic images were divided into training (n = 1370), validation (n = 150), and test (n = 150) datasets. The system was evaluated in terms of sensitivity, specificity, the mistake diagnostic rate, the omission diagnostic rate, and the positive predictive value. Kappa (κ) statistics were compared between the system and dental clinicians. Results Evaluation metrics of AI system is equal to resident dentist. The agreement between the AI system and expert is moderate to substantial (κ = 0.547 and 0.568 for bone loss sites and bone loss implants, respectively) for detecting marginal bone loss around dental implants. Conclusions This AI system based on Faster R-CNN analysis of periapical radiographs is a highly promising auxiliary diagnostic tool for peri-implant bone loss detection.

Effects of insertion torque values on the marginal bone loss of dental implants installed in sheep mandibles

The aim of the present in vivo study was to analyze and compare the effects on the crestal bone healing of two different implant macrogeometries installed in fresh socket areas and in normal bone areas with different insertion torque values. Two implant macrogeometries were used in the present study, DuoCone implant (DC) and Maestro implant (MAE), forming four groups: group DCws, in which the implants were installed in healing bone (without a socket); group DCfs, in which the implants were installed in post-extraction areas (fresh sockets); group MAEws, in which the implants were installed in healing bone (without a socket); group MAEfs, in which the implants were installed in post-extraction areas (fresh sockets). After 30 and 90 days of implantations in the bilateral mandibles of 10 sheep, eighty implants were evaluated through digital X-ray images and histologic slices. The crestal bone position in relation to the implant platform shoulder was measured and compared. The measured insertion torque was 47.2 ± 4.69 Ncm for the DCws group, 43.4 ± 4.87 Ncm for the DCfs group, 29.3 ± 3.16 Ncm for the MAEws group, and 27.7 ± 4.41 Ncm for the MAEfs group. The radiographic mesio-distal and histological bucco-lingual analyses showed significantly greater vertical bone loss in the implants installed with high torque (DC groups) in comparison to the implants installed with a low torque (MAE groups) (p < 0.05), at both evaluation times. In general, low insertion torque values (Maestro implants) showed better results of MBL when compared to implants installed with higher torque values (Duo Cone implants). Moreover, our results showed that the implants installed in the sites without sockets showed a less MBL in comparison with the implants installed in sites of fresh sockets.

Comparison between Early Loaded Single Implants with Internal Conical Connection or Implants with Transmucosal Neck Design: A Non-Randomized Controlled Trial with 1-Year Clinical, Aesthetics, and Radiographic Evaluation

To evaluate the implant and prosthetic of two implants with different surfaces and neck design. Enrolled patients received bone level, 12° conical connection implants (Nobel Parallel, Nobel Biocare; NOBEL group) with anodized surface (TiUnite) and roughness of 1.35 μm, or transmucosal implant system (Prama, Sweden and Martina; PRAMA group) with convergent collar, ZIrTi surface, and roughness 1.4–1.7 μm. Both implants were made of pure grade IV titanium, with similar diameter and length, chosen according to the dentistry department availability and patient’s request. After early prosthesis delivery, patients were filled for at least one year. Outcome measures were: implant and prosthetic survival and success rates, physiological marginal bone remodeling, periodontal parameters and pink esthetic score (PES). Results: Fifteen patients were allocated and treated in each group. At the one-year follow-up, three patients dropped out, one in the NOBEL group and two in the PRAMA group. During the entire time of investigation, all implants survived and the prostheses were successful. No statistically significant differences were found in term of marginal bone loss, periodontal parameters, and aesthetics (p > 0.05). Conclusion: With the limitations of the present study, both implant systems showed successful clinical results. Finally, many other clinical and surgical variables may influenced marginal bone levels, implant survival, and periodontal parameters. More homogenous clinical trials with larger samples are needed to confirm these preliminary conclusions.

Correlation between Peri-Implant Marginal Bone Loss Progression and Peri-Implant Sulcular Fluid Levels of Metalloproteinase-8

Objectives: The aim of this retrospective study was to analyze peri-implant marginal bone loss levels/rates and peri-implant sulcular fluid levels/rates of metalloproteinase-8 in three timeframes (6 months post-surgery—restoration delivery (T0)—and 6 (T6) and 24 (T24)-months post-loading) and to evaluate if there is a correlation between peri-implant sulcular fluid levels of metalloproteinase-8 and peri-implant marginal bone loss progression. Materials and Methods: Two cohorts of patients undergoing implant surgery between January 2017 and January 2019 were selected in this retrospective study. A total of 39 patients received 39 implants with a laser-microtextured collar surface, and 41 subjects received 41 implants with a machined/smooth surface. For each patient, periapical radiographs and a software package were used to measure marginal bone loss rates. Implant fluid samples were analyzed by an enzyme-linked immunosorbent assay (ELISA) test. The modified plaque index, probing depth, and bleeding on probing were also recorded. Results: High marginal bone rates at T24 were strongly associated with elevated rates between T0 and T6. The levels of metalloproteinase-8 were significantly more elevated around implants with marginal bone loss, in relation to implants without marginal bone loss. Marginal bone loss (MBL) rates at 24 months were associated with initial bone loss rates and initial levels of metalloproteinase-8. Conclusions: Peri-implant marginal bone loss progression is statistically correlated to peri-implant sulcular fluid levels of metalloproteinase-8. Moreover, the initial high levels of marginal bone loss and metalloproteinase-8 can be considered as indicators of the subsequent progression of peri-implant MBL: implants with increased marginal bone loss rates and metalloproteinase-8 levels at 6 months after loading are likely to achieve additional marginal bone loss values.

A Clinical and Radiographic Evaluation of Zirconia Dental Implants: 10-Year Follow-Up

Purpose. The aim is to evaluate the survival and success rates, as well as the marginal bone loss (MBL) and periodontal indexes, of zirconia implants with 10-year follow-up. Materials and Methods. 10 patients were selected and 26 one-piece zirconia implants were used for the rehabilitation of single tooth or partially edentulous ridge. After 10 years, a clinical-radiographic evaluation was performed in order to estimate peri-implant tissue health and marginal bone loss. Results. The survival and success rates were 100%. The average marginal bone loss from baseline to 120 months after surgery was 0.92 ± 0.97 mm. Conclusion. One-piece zirconia dental implants are characterised by high biocompatibility, low plaque adhesion, and absence of microgap that can be related to the clinical success of these implants.

The Effect of Different Implant-Abutment Mis-Matches on Stress Distribution: A 3-Dimensional Finite Element Study

Platform-switching reduces peri-implant marginal bone loss (MBL), and the aim of this study was to compare the effect of platform-switching on stress within crestal bone using different implant-abutment mis-matches (0.65 and 1mm) under two different vertical loads (30 N vs 200 N) for implants placed in posterior jaw sites. 3-D modeling software was used for an implant of 4.5mm diameter and 13mm length. Molars were modeled using CT images of bone density in human maxilla (D3 bone) and mandible (D2 bone). Collected data were analyzed using CATIA software. In posterior mandible, stress of 30 N force with platform mis-matches of 0.65 or 1mm were 2.920 and 2.440 MPa respectively. Using 200 N force, values increased to 19.44 and 16.30 MPa. In posterior maxilla and 30 N force, stresses with mis-matches of 0.65 and 1mm were 3.77 and 3.18 MPa respectively increasing to 25.14 & 20.17 with 200 N force. The effect can be predicted to be greatest as the mis-match increases with implants placed into lower quality bone (posterior maxilla with D3 quality).

Physics Forceps in Tooth Extraction—A Systematic Review of Randomized Controlled Trials

The present systematic review aims to evaluate the efficiency of Physics forceps over the conventional forceps for the extraction of a tooth. The study began with targeted electronic searches of MEDLINE, PubMed, Cochrane, Science Direct and Google Scholar databases. All selected articles were reviewed by four independent reviewers for eligibility. The Cochrane Risk of Bias tool was used to analyze the studies for bias. Due to heterogeneity of the selected studies, a meta-analysis of the current systematic review was not possible. A total of five studies were considered for the final analysis. The risk of bias showed high risk for all five included articles. Various parameters, such as fracture of the root, dry socket, healing, pain, postoperative infection, crown fractures, buccal bone fractures, extraction time, gingival and marginal bone loss, gingival laceration, bleeding and healing were assessed. Based on the data available, there is an insufficient quality of evidence to conclude the superiority of the Physics forceps over conventional forceps.

Smoking and Dental Implants: A Systematic Review and Meta-Analysis

Background and Objectives: Tobacco is today the single most preventable cause of death, being associated with countless diseases, including cancer and neurological, cardiovascular, and respiratory diseases. Smoking also brings negative consequences to oral health, potentially impairing treatment with dental implants. The present review aimed to evaluate the influence of smoking on dental implant failure rates and marginal bone loss (MBL). Materials and Methods: Electronic search was undertaken in three databases, plus a manual search of journals. Meta-analyses were performed, in addition to meta-regressions, in order to verify how the odds ratio (OR) and MBL were associated with follow-up time. Results: The review included 292 publications. Altogether, there were 35,511 and 114,597 implants placed in smokers and in non-smokers, respectively. Pairwise meta-analysis showed that implants in smokers had a higher failure risk in comparison with non-smokers (OR 2.402, p < 0.001). The difference in implant failure between the groups was statistically significant in the maxilla (OR 2.910, p < 0.001), as well as in the mandible (OR 2.866, p < 0.001). The MBL mean difference (MD) between the groups was 0.580 mm (p < 0.001). There was an estimated decrease of 0.001 in OR (p = 0.566) and increase of 0.004 mm (p = 0.279) in the MBL MD between groups for every additional month of follow-up, although without statistical significance. Therefore, there was no clear influence of the follow-up on the effect size (OR) and on MBL MD between groups. Conclusions: Implants placed in smokers present a 140.2% higher risk of failure than implants placed in non-smokers.

The Association of the One-Abutment at One-Time Concept with Marginal Bone Loss around the SLA and Platform Switch and Conical Abutment Implants

Objectives: Repeated abutment disconnection/reconnection may compromise the mucosal barrier and result in crestal bone level changes. The clinical significance of this phenomenon is not yet clear, as most studies on this topic are short-term. Therefore, the aim of the present study was to evaluate the influence of abutment disconnections and reconnections on peri-implant marginal bone loss over a medium-term follow-up period. Material and methods: Twenty-one patients (6 men and 15 women) with a mean age 66.23 ± 9.35 year at the time of implant placement were included. All patients who received two adjacent nonsubmerged implants were randomly assigned into one of the two groups: definitive multiunit abutments (DEFs) connected to the implant that were not removed (test group) or healing abutments (HEAs) placed at surgery, which were disconnected and reconnected 3–5 times during the prosthetic phase (control group). Peri-implant marginal bone levels (MBL) were measured through periapical X-rays images acquired immediately after the surgery (baseline), at 4–7 months immediately after prosthetic delivery, and at 1-year and 3-year follow-up visits. Results: No implant was lost or presented bone loss of more than 1.9 mm during the 3-year follow-up; thus, the survival and success rate was 100%. Peri-implant mucositis was noticed in 38.1% DEFs and 41.9% of HEAs at the 3-year follow-up assessment. At the end of 3 years, the MBL was −0.35 ± 0.69 mm for participants in the DEFs group and −0.57 ± 0.80 mm for the HEAs group, with significant statistical difference between groups. Conclusions: Immediate connection of the multiunit abutments reduced bone loss in comparison with 3–5 disconnections noted in the healing abutments 3 years after prosthetic delivery. However, the difference between the groups was minimal; thus, the clinical relevance of those results is doubtful.

Rehabilitation of the Completely Edentulous Mandible by All-on-Four Treatment Concept: A Retrospective Cohort Study with Up to 10 Years Follow-Up

(1) Background and Objectives. Currently, there are no definitive long-term data about clinically significant difference in the failure of prosthesis and implant or marginal bone loss related to the rehabilitation of the completely edentulous mandible by all-on-four treatment concept. The main aim of present investigation was to report the long-term outcomes (10-years follow-up) of complete-arch mandibular rehabilitations based on the all-on-four concept. (2) Materials and Methods. Patients in need of extractions of teeth due to the occurrence of caries and/or severe periodontal disease and patients presented with edentulous mandibles were enrolled to the study. A total of 96 participants (mean follow-up period after intervention of 3185.2 days) were enrolled in the study. Participants were evaluated at the first visit, 10 days after intervention and every year after the intervention. Implant and prosthesis survival, bone loss and both local biological and mechanical complications were evaluated during the follow-up period. (3) Results. An implants’ survival rate of 97.9% was observed at the end of the follow-up period. Biological complications were reported in 19.8% of patients, whereas mechanical complications were reported in 27.1% of cases. The average marginal bone level at baseline was −0.03 mm. A significant marginal bone loss was observed after 10-years follow-up (2.5 mm). Binary logistic regression analysis showed significant association between smoke and both marginal bone loss and local biological complications. Lastly, a significant association was observed between bruxism and mechanical complications. (4) Conclusions. The high implant and prosthesis survival rate and the moderate incidence of biological and mechanical complications observed in present investigation can be associated to several factors such as high implant primary stability, prosthetic design, and control of the occlusal forces.