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Clinical Oral Implants Research Mar 2016The aim of this systematic review was to evaluate clinical, radiological and histological outcomes of the alveolar ridge splitting/expansion technique (ARST) with or... (Review)
Review
PURPOSE
The aim of this systematic review was to evaluate clinical, radiological and histological outcomes of the alveolar ridge splitting/expansion technique (ARST) with or without GBR.
MATERIALS AND METHODS
A screening of two databases MEDLINE (PubMed) and EMBASE (OVID) and hand search of articles were performed. Human and animal studies reporting on dental implants placed with simultaneous ARST up to May 31st 2014 were considered. Quality assessment of selected full-text articles was performed according to the ARRIVE guidelines and the Cochrane collaboration's tool to assess risk of bias.
RESULTS
Overall, 18 human and six animal studies (risk of bias: high/unclear) were included in this review. No randomized controlled trials were found. Due to the heterogeneity of study designs, definitions of success criteria, outcome variables, observation times and surgical procedures, no meta-analysis was performed. Reported survival (18 studies) and success (nine studies) rates ranged from 91.7 to 100% and 88.2 to 100%, respectively, with a mean follow-up of 1-10 years. Crestal bone level changes (∆CBL) in some studies indicate slightly higher bone loss before and after loading. Histologic and histomorphometric data from six animal studies confirm the crestal bone loss, particularly at buccal sites.
CONCLUSIONS
Within the limitations of this review, ARST seems to be a well-functioning one-stage alternative to extended two-stage horizontal grafting procedures. Data indicate that during healing and first year of loading, increased ∆CBL particularly at buccal sites must be anticipated. Additional horizontal GBR can help to preserve buccal bone height and width.
Topics: Alveolar Bone Loss; Alveolar Ridge Augmentation; Animals; Bone Transplantation; Dental Implantation, Endosseous; Dental Implants; Guided Tissue Regeneration, Periodontal; Humans
PubMed: 25586966
DOI: 10.1111/clr.12537 -
Journal of Clinical Periodontology Nov 2023To systematically appraise the available evidence on vertical ridge augmentation (VRA) techniques and estimate a treatment-based ranking on the incidence of... (Meta-Analysis)
Meta-Analysis Review
Comparative evidence of different surgical techniques for the management of vertical alveolar ridge defects in terms of complications and efficacy: A systematic review and network meta-analysis.
AIM
To systematically appraise the available evidence on vertical ridge augmentation (VRA) techniques and estimate a treatment-based ranking on the incidence of complications as well as their clinical effectiveness.
MATERIALS AND METHODS
Searches were conducted in six databases to identify randomized clinical trials comparing VRA techniques up to November 2022. The incidence of complications (primary) and of early, major, surgical and intra-operative complications, vertical bone gain (VBG), marginal bone loss, need for additional grafting, implant success/survival, and patient-reported outcome measures (secondary) were chosen as outcomes. Direct and indirect effects and treatment ranking were estimated using Bayesian pair-wise and network meta-analysis (NMA) models.
RESULTS
Thirty-two trials (761 participants and 943 defects) were included. Five NMA models involving nine treatment groups were created: onlay, inlay, dense-polytetrafluoroethylene, expanded-polytetrafluoroethylene, titanium, resorbable membranes, distraction osteogenesis, tissue expansion and short implants. Compared with short implants, statistically significant higher odds ratios of healing complications were confirmed for all groups except those with resorbable membranes (odds ratio 5.4, 95% credible interval 0.92-29.14). The latter group, however, ranked last in clinical VBG.
CONCLUSIONS
VRA techniques achieving greater VBG are also associated with higher incidence of healing complications. Guided bone regeneration techniques using non-resorbable membranes yield the most favourable results in relation to VBG and complications.
Topics: Humans; Dental Implantation, Endosseous; Bayes Theorem; Network Meta-Analysis; Alveolar Ridge Augmentation; Alveolar Process; Bone Regeneration; Polytetrafluoroethylene; Bone Transplantation; Membranes, Artificial; Dental Implants; Guided Tissue Regeneration, Periodontal
PubMed: 37495541
DOI: 10.1111/jcpe.13850 -
Journal of Clinical Periodontology Jan 2021To analyse the evidence pertaining to post-extraction dimensional changes in the alveolar ridge after unassisted socket healing. (Meta-Analysis)
Meta-Analysis Review
AIM
To analyse the evidence pertaining to post-extraction dimensional changes in the alveolar ridge after unassisted socket healing.
MATERIALS AND METHODS
The protocol of this PRISMA-compliant systematic review (SRs) was registered in PROSPERO (CRD42020178857). A literature search to identify studies that fulfilled the eligibility criteria was conducted. Data of interest were extracted. Qualitative and random-effects meta-analyses were performed if at least two studies with comparable features and variables reported the same outcome of interest.
RESULTS
Twenty-eight articles were selected, of which 20 could be utilized for the conduction of quantitative analyses by method of assessment (i.e. clinical vs radiographic measurements) and location (i.e. non-molar vs molar sites). Pooled estimates revealed that mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed clinically in non-molar sites was 2.73 mm (95% CI: 2.36-3.11), 1.71 mm (95% CI: 1.30-2.12) and 1.44 mm (95% CI: 0.78-2.10), respectively. Mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed radiographically in non-molar sites was 2.54 mm (95% CI: 1.97-3.11), 1.65 mm (95% CI: 0.42-2.88) and 0.87 mm (95% CI: 0.36-1.38), respectively. Mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed radiographically in molar sites was 3.61 mm (95% CI: 3.24-3.98), 1.46 mm (95% CI: 0.73-2.20) and 1.20 mm (95% CI: 0.56-1.83), respectively.
CONCLUSION
A variable amount of alveolar bone resorption occurs after unassisted socket healing depending on tooth type.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Humans; Tooth Extraction; Tooth Socket
PubMed: 33067890
DOI: 10.1111/jcpe.13390 -
Annals of Anatomy = Anatomischer... Feb 2023This review aimed to investigate the clinical outcomes of autogenous particulated dentin (APD) used for alveolar ridge preservation (ARP), evaluating volume gain,...
PURPOSE
This review aimed to investigate the clinical outcomes of autogenous particulated dentin (APD) used for alveolar ridge preservation (ARP), evaluating volume gain, histologic/histomorphometric data, and associated complications.
MATERIAL AND METHODS
The review followed PRISMA guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO). An automated search was made in four databases (Medline/Pubmed, Scopus, Web of Science, and Cochrane Library) supplemented by a manual search for relevant clinical articles published before March 10th, 2022. The review included human studies of at least four patients in which extraction and subsequent ARP were performed in a single surgery. Both comparative studies and studies that assessed ARP with APD exclusively were admitted. The quality of evidence was assessed with the Cochrane bias assessment tool, the Newcastle-Ottawa Quality Assessment Scale, and the Joanna Briggs Institute Critical Appraisal tool.
RESULTS
Eleven studies fulfilled the inclusion criteria and were included for descriptive analysis, with a total of 215 patients, and 337 alveoli preserved by APD, spontaneous healing (blood clot), or other bone substitutes, obtaining comparatively less vertical and horizontal resorption when APD was used.
CONCLUSIONS
After dental extraction, autogenous dentin was effective in terms of volume maintenance, showing promising results in histologic/histomorphometric analysis, and a low complication rate. Nevertheless, few comparative studies with comparable parameters have been published and so more research providing long-term data is needed to confirm these findings.
Topics: Humans; Alveolar Ridge Augmentation; Bone Transplantation; Bone Substitutes; Minerals; Alveolar Process; Dentin; Tooth Socket; Tooth Extraction
PubMed: 36396018
DOI: 10.1016/j.aanat.2022.152024 -
Implant Dentistry Jun 2018The main focused question of this systematic review was as follows: Does the application of recombinant human bone morphogenetic protein-2 (rhBMP-2) placed in extraction... (Review)
Review
PURPOSE
The main focused question of this systematic review was as follows: Does the application of recombinant human bone morphogenetic protein-2 (rhBMP-2) placed in extraction sockets reduce the alveolar ridge changes?
METHODS
A systematic literature search was performed up to February 2017. Clinical studies published in English were included. Outcome variables of interest were as follows: changes in alveolar ridge width and height, the quality of new bone, patient's safety, adverse events, and postoperative complications.
RESULTS
Seven articles were included. Because of the vast heterogeneity and high risk of bias among the studies, performing a meta-analysis deemed not feasible. Application of rhBMP-2 in the extraction socket was more effective in the reduction of ridge width compared with that of ridge height. The superiority of 1.5 mg/mL rhBMP-2/absorbable collagen sponge over the carrier alone on alveolar ridge width/height remodeling was more significant when it was applied in the sockets with ≥50% buccal bone dehiscence. The limited available data showed that rhBMP-2 did not improve the quality of new bone. Antibodies against rhBMP-2 were detected in the serum in 1 trial.
CONCLUSIONS
Within the limits of this review, 1.5 mg/mL rhBMP-2 might be beneficial for preserving the alveolar ridge width within extraction sockets given as to whether the cost-effectiveness is justifiable. Studies with lower risk of bias should be performed to confirm the above findings.
Topics: Alveolar Bone Loss; Alveolar Ridge Augmentation; Bone Morphogenetic Protein 2; Humans; Recombinant Proteins; Tooth Extraction; Tooth Socket; Transforming Growth Factor beta
PubMed: 29394177
DOI: 10.1097/ID.0000000000000722 -
The International Journal of Oral &... 2015Many techniques have been proposed to overcome the limitations displayed by maxillary atrophy. The aim of this systematic review was to assess the predictability,... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Many techniques have been proposed to overcome the limitations displayed by maxillary atrophy. The aim of this systematic review was to assess the predictability, dimensional changes, and associated factors to successfully perform the alveolar ridge split (ARS) technique of augmentation.
MATERIALS AND METHODS
An electronic and manual literature searches was conducted by two independent reviewers in several databases, including Medline, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register, for articles written in English up to February 2014. A manual search was also performed to ensure a thorough screening process. Based on the PICO (problem, intervention, comparison, outcome) model, the chief question of this study was: Can patients with horizontal ridge deficiency be successfully treated with the ARS technique and implant therapy?
RESULTS
Overall, 17 articles met the inclusion criteria, and a subsequent meta-analysis was performed. A Cohen kappa interagreement rate of 0.82 was reached. The implant survival rate of the included studies was 97.0% (range, 94.4% to 100%) with the full-thickness flap (FTF) approach and 95.7% (range, 86.6% to 100%) with the partial-thickness flap (PTF) approach. The weighted mean (WM) of horizontal bone width gain was calculated for included studies using FTF for the ARS technique. Four studies that had data were included in the meta-analysis. The WM ± standard deviation of bone width gain was 3.19 ± 1.19 mm (range, 2.00 to 4.03 mm). For studies using PTF for ARS, only one study provided mean and standard deviation of horizontal bone width gain (4.13 ± 3.13 mm); hence, meta-analysis could not be performed. Buccal wall fracture represented the most frequent postoperative complication, followed by postoperative ridge resorption.
CONCLUSION
In selected scenarios, the ARS technique might represent a predictable approach as demonstrated by a high implant survival rate, adequate horizontal bone gain, and minimal intra- and postoperative complications. Further research is needed to determine the influence of the grafting materials inserted and flap tissue biotype, as well as the anatomical characteristics on final bone augmentation outcomes.
Topics: Algorithms; Alveolar Bone Loss; Alveolar Process; Clinical Trials as Topic; Collagen; Dental Implantation, Endosseous; Dental Implants; Humans; Maxilla; Osteotomy; Postoperative Complications; Reproducibility of Results; Research Design
PubMed: 26009911
DOI: 10.11607/jomi.4051 -
Clinical Oral Investigations Aug 2023To investigate the histomorphometric changes occurring in alveolar ridge preservation (ARP) based on the use of different plasma concentrates (PCs) in randomized... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To investigate the histomorphometric changes occurring in alveolar ridge preservation (ARP) based on the use of different plasma concentrates (PCs) in randomized clinical trials (RCT). There is controversy whether the placement of PCs in ARP is effective in the formation of new bone.
MATERIALS AND METHODS
A systematic review search was conducted in PubMed, Scopus, Web of Science, and Cochrane Database to answer the PICO question: In patients undergoing tooth extraction followed by ARP, do PCs alone in the post-extraction socket in comparison with spontaneous healing improve new vital bone formation percentage in histomorphometric analysis after more than 10 weeks? The risk of bias was assessed and a meta-analysis was conducted.
RESULTS
Of 3809 results, 8 studies were considered suitable for inclusion. A total of 255 teeth were extracted in 250 patients. Regarding the PCs used, ARP was performed with platelet- and leukocyte-rich fibrin (L-PRF) in 120 sockets, and with pure platelet-rich plasma (P-PRP) in 31 sockets and 104 sockets were controlled. PCs improved new bone formation in ARP with respect to the spontaneous healing group (SMD = 1.77, 95%C.I. = 1.47-2.06, p-value < 000.1). There were no differences between the different PCs (L-PRF and P-PRP).
CONCLUSION
The results of this meta-analysis support the efficacy of the use of PCs in new bone formation in ARP. With respect to the different types of PCs studied, no differences were observed.
CLINICAL RELEVANCE
When planning implant surgery after tooth extraction, treatment with PCs should be considered for ARP. Any PC increases new bone formation compared to spontaneous healing.
Topics: Humans; Tooth Socket; Alveolar Process; Osteogenesis; Tooth; Platelet-Rich Plasma; Tooth Extraction; Fibrin; Alveolar Ridge Augmentation
PubMed: 37439800
DOI: 10.1007/s00784-023-05126-8 -
Journal of Oral Rehabilitation Aug 2018Splinted and unsplinted overdenture attachment systems have unique advantages and disadvantages. The aim of the present systematic review was to determine the influence... (Meta-Analysis)
Meta-Analysis Review
Splinted and unsplinted overdenture attachment systems have unique advantages and disadvantages. The aim of the present systematic review was to determine the influence of splinted and unsplinted overdenture attachment systems on the marginal bone loss, prosthetic complications and implant survival rate. PubMed/MEDLINE, Scopus and Cochrane databases were searched for articles published up to October 2017, using the following search terms: "overdenture AND attachment OR overdenture AND bar OR overdenture splinted." The PICO question "Do splinted overdenture attachment systems promote better clinical results in comparison to unsplinted systems?" was evaluated. Eligible studies included randomized controlled clinical trials, prospective studies with at least 10 participants and a minimum follow-up of 6 months, and studies published in English that compared splinted and unsplinted attachment systems within the same study. The 95% confidence interval (CI) was considered for all outcomes analysed. After completion of the different steps in the article selection process, nine articles were included in the qualitative and quantitative analyses. A total of 984 implants were placed in 380 patients (mean age: 62.8 years). The meta-analysis demonstrated no statistically significant differences between splinted and unsplinted attachment systems with regard to marginal bone loss (P = .39; MD: -0.11; 95% CI: -0.37 to 0.14), complications (P = .31; RR: 1.26; CI: 0.80-1.99) and implant survival rate (P = .14; RR: 0.37% CI: 0.10-1.36). In addition, splinted and unsplinted overdenture attachment systems achieved similar results with regard to marginal bone loss, prosthetic complications and implant survival rate.
Topics: Alveolar Bone Loss; Dental Implants; Dental Prosthesis, Implant-Supported; Denture Design; Denture Precision Attachment; Denture Retention; Denture, Overlay; Humans; Osseointegration; Periodontal Attachment Loss
PubMed: 29761853
DOI: 10.1111/joor.12651 -
Clinical Implant Dentistry and Related... Feb 2024The present systematic review aimed to identify and summarize the clinical, radiographic, and histological outcomes of alveolar ridge preservation using bone xenografts... (Meta-Analysis)
Meta-Analysis Review
AIM
The present systematic review aimed to identify and summarize the clinical, radiographic, and histological outcomes of alveolar ridge preservation using bone xenografts and absorbable sealing materials compared with spontaneous healing in the esthetic zone.
MATERIALS AND METHODS
Randomized clinical trials (RCTs) fulfilling specific eligibility criteria were included. Two review authors independently searched for eligible studies, extracted data from the published reports and performed the risk of bias assessment (RoB 2 tool). Study results were summarized using random effects meta-analyses.
RESULTS
Thirteen articles concerning 10 RCTs were included, involving a total of 357 participants. Most of studies were considered as "low" risk of bias. Meta-analyses indicated less horizontal (difference in means-MD = 1.88 mm; p < 0.001), vertical mid-buccal (MD = 1.84 mm; p < 0.001) and vertical mid-lingual (MD = 2.27 mm; p < 0.001) bone resorption in alveolar ridge preservation compared to spontaneous healing as assessed clinically. Bone changes assessed radiographically showed consistent results in terms of horizontal (at 1 mm: MD = 1.84 mm, p < 0.001), vertical mid-buccal (MD = 0.95 mm; p < 0.001) and mid-lingual (MD = 0.62 mm; p = 0.05) resorption. Part of the bone resorption in the spontaneous healing group was compensated by soft-tissues, since the observed differences between groups in linear ridge reduction evaluated through cast models superimposition were smaller (MD = 0.52 mm; p < 0.001).
CONCLUSIONS
Alveolar ridge preservation with xenogeneic bone substitutes and non-autogenous resorbable socket sealing materials is efficacious in reducing post-extraction bone and ridge changes in the esthetic region.
Topics: Humans; Alveolar Process; Tooth Socket; Alveolar Ridge Augmentation; Alveolar Bone Loss; Heterografts; Remission, Spontaneous; Tooth Extraction; Esthetics, Dental
PubMed: 37674334
DOI: 10.1111/cid.13257 -
Medicina Oral, Patologia Oral Y Cirugia... Nov 2014Alveolar bone regeneration by means of titanium meshes is a widespread procedure, however to date, only few relevant studies were reported in literature concerning this... (Review)
Review
Alveolar bone regeneration by means of titanium meshes is a widespread procedure, however to date, only few relevant studies were reported in literature concerning this technique. Consequently, the aim of the present systematic review was to analyze the reliability of the titanium mesh as a barrier, in conjunction with horizontal and vertical ridge reconstruction for implant placement purposes. A total of 17 articles complying with the inclusion and exclusion criteria were reviewed. Three outcome variables were defined: a) horizontal and vertical bone regeneration obtained, b) complication rate, defined as the percentage of membrane exposures and c) evaluation of implant survival, success and failure rate.In regards to the vertical regeneration the mean was 4.91 mm (range: 2.56 - 8.6), while a mean of 4.36 mm (range: 3.75 - 5.65) was calculated for horizontal reconstruction.Considering the exposure rate, a mean of 16.1% was found, nevertheless, implant placement were placed in almost all of the sites. A mean success rate of 89,9%, a mean survival rate of 100% and a failure rate of 0% emerged from the data evaluation. A meta-analysis could not be performed due to the heterogeneity of the data, however the final results were comparable with those reported in case of bone regeneration obtained through other types of non-resorbable membranes. An advantage in favour of the titanium mesh was found in terms of bone loss after exposure, as implant placement was not jeopardized in almost all of the cases. It could be deduced that titanium meshes represented a reliable solution for alveolar ridge reconstruction. The clinical studies currently available in literature have shown the predictability of this technique in both lateral and vertical bone regeneration.
Topics: Alveolar Ridge Augmentation; Bone Regeneration; Surgical Mesh; Titanium
PubMed: 25350597
DOI: 10.4317/medoral.19998