Objectives: The aim of the study was to report two clinical cases of HIV-positive patients on highly active anti-retroviral therapy (HAART) who received implant-supported rehabilitation after bone reconstruction procedures and were followed for up to 10 years. Methods: Case 1 was a 44-year-old women who was referred to treatment because of persistent symptomatic apical periodontitis in elements #30 and #29. During exploratory endodontic surgery, in an attempt to retain her teeth, a longitudinal fracture and extensive bone dehiscence were detected in #29 and replacement by dental implant was planned. Viral load was undetectable and CD4/CD8 counts were compatible with an immunocompetent condition. In a second event, tooth #29 was extracted and the large bone defect filled with a mixture of autogenous bone plus bovine hydroxyapatite. A collagen membrane was used as a barrier. The implant was placed, and after the osseointegration period a metal–ceramic crown was installed. The 10-year follow-up appointment and control x-rays showed healthy and stable peri-implant tissues. Case 2 was a 47-year-old man who was referred for replacement of an upper molar with severe bone loss and close relation with the pneumatised sinus. He had been on HAART for approximately 8 years. Viral load was undetectable and the patient was considered able the receive the intervention. The tooth was extracted and socket preservation techniques were used (bone substitute plus collagen membrane). After healing, a sinus lift procedure was performed with the lateral window technique, using bovine hydroxyapatite and collagen membrane. The implant was placed at the same time. The patient healed uneventfully and has been followed for 8 years with good results. Results: Both HIV-positive patients undergoing HAART had undetectable viral loads and white cell counts (CD4/CD8) within a range that is compatible with dental interventions. Both received antibiotic cover with amoxicillin 500mg and clavulanic acid 125mg three times daily for one week to prevent postoperative infection. They were prescribed ibuprofen 600mg three times daily to control postoperative discomfort. Both patients were followed by an assistant physician who allowed them to undergo the planned dental intervention. All the interventions healed uneventfully and both patients were able to receive the prosthesis within the planned treatment period. At biannual follow-up in a periodontal maintenance program, implants were functional, without clinical or radiographic signs of peri-implantitis or mucositis. The patients maintained satisfying levels of oral hygiene and did reported no significant systemic alterations. Both had undetectable viral loads and good CD4/CD8 counts. Conclusion: HIV-positive patients undergoing HAART are usually able to maintain good systemic conditions and therefore may be eligible to receive implant-supported restorations. In both cases presented, follow-up showed stable and healthy peri-implant tissues and functional implants. Literature on this topic is still restricted to few studies with small samples, but previously published data suggest that well-controlled HIV-positive patients can benefit from dental implants, even when bone augmentation procedures are needed. The need for antibiotic coverage is still controversial.

Clinical steps for the fabrication of implant-supported restorations - Single-tooth restoration - Fixed partial denture - Electroplated cone-retained restoration - Conical copings using a pre-fabricated abutment matrix system