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BMC Oral Health Nov 2023To evaluate the effects of the alveolar ridge split (ARS) technique on gained horizontal width of the alveolar ridge and implant survival rate. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate the effects of the alveolar ridge split (ARS) technique on gained horizontal width of the alveolar ridge and implant survival rate.
MATERIALS AND METHODS
Electronic searching was performed in six electronic databases (Pubmed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, and SIGLE) from January 1, 2010, to November 1, 2023. Two authors performed study selection, data extraction, and study qualities (ROBINS-I and RoB 2.0) independently. Meta-analysis was performed by Comprehensive meta-analysis 3.0.
RESULTS
24 included studies were observational, and 1 study was a randomized controlled trial (RCT). 14 studies investigated the gained width of the horizontal alveolar ridge, and 17 examined the implants' survival rate. For assessment of risk of bias, nine studies were high risk of bias and 16 studies were moderate risk of bias. Meta-analysis demonstrated that the pooled gained alveolar ridge width was 3.348 mm (95%CI: 4.163 mm, 2.533 mm), and the implant survival rate was 98.1% (95%CI: 98.9%, 96.9%). Seven studies showed seven different complications including exposure, infection, bad split, dehiscence, fracture, paresthesia and soft tissue retraction.
CONCLUSION
Recent ARS technique seems to be an effective method of bone augmentation with enough gained width and a high implant survival rate. Further long-term and RCTs research remains needed to enhance the study quality.
CLINICAL RELEVANCE
The ARS technique could generate sufficient bone volume, and implants had a high-level survival rate. Therefore, ARS has been proposed to be a reliable horizontal bone augmentation technique that creates good conditions for the implantation of narrow alveolar crests.
Topics: Humans; Dental Implantation, Endosseous; Dental Implants; Alveolar Ridge Augmentation; Alveolar Process; Bone Transplantation; Randomized Controlled Trials as Topic
PubMed: 37986181
DOI: 10.1186/s12903-023-03643-2 -
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 -
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 -
Bioengineering (Basel, Switzerland) Jun 2024Alveolar preservation techniques for esthetic or functional purposes, or both, are a frequently used alternative for the treatment of post-extraction sockets, the aim of... (Review)
Review
BACKGROUND
Alveolar preservation techniques for esthetic or functional purposes, or both, are a frequently used alternative for the treatment of post-extraction sockets, the aim of which is the regeneration of the lesion and the preservation of the alveolar bone crest.
METHODS
Studies published in PubMed (Medline), Web of Science, Embase, and Cochrane Library databases up to January 2024 were consulted. Inclusion criteria were established as intervention studies, according to the PICOs strategy: adult subjects undergoing dental extractions (participants), with alveoli treated with bone mineral grafts and collagen membranes (intervention), compared to spontaneous healing (comparison), and observing the response to treatment in clinical and radiological measures of the alveolar bone crest (outcomes).
RESULTS
We obtained 561 results and selected 12 studies. Risk of bias was assessed using the Cochrane Risk of Bias Tool, and methodological quality was assessed using the Joanna Briggs Institute. Due to the high heterogeneity of the studies (I > 75%), a random-effects meta-analysis was used. Despite the trend, no statistical significance ( > 0.05) was found in the experimental groups.
CONCLUSIONS
The use of bone mineral grafts in combination with resorbable collagen barriers provides greater preservation of the alveolar ridge, although more clinical studies are needed.
PubMed: 38927801
DOI: 10.3390/bioengineering11060565 -
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 -
National Journal of Maxillofacial... 2023The alveolar ridge split and expansion (ARSE) can be performed using conventional devices (osteotome/chisel) or modern devices (ultrasonographic [USG], motorized ridge... (Review)
Review
The alveolar ridge split and expansion (ARSE) can be performed using conventional devices (osteotome/chisel) or modern devices (ultrasonographic [USG], motorized ridge expansion [MRE], etc.). The aim of this systematic review was to evaluate the effect of modern devices for ARSE. This review has been registered at PROSPERO under the number CRD42020213264. A systematic search was conducted by two reviewers independently in databases PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Grey Open, Hand search of reference lists of relevant studies, and previously published systematic reviews. The article published until September 2020 were searched for this review. The searches identified 24 eligible studies, twenty-two cohort and two randomized control trial studies. A total of 1287 dental implants were installed in 634 patients with the age range of 17-70 years and a minimum of 3 months of follow-up. Ten articles of USG device and seven of MRE device were finally evaluated for metanalysis. The mean ridge width gain was 3.40 mm (USG device) and 2.83 mm (MRE device). The overall implant survival rate was 98.07%. Mean width gain between USG and MRE devices was significantly different ( < 0.0001, HS). Test of heterogeneity was significant ( = 88.3877, < 0.0001, HS) and there was no publication bias (Intercept = 6.6634, = 0.6142, NS) by Egger's test. The most commonly used devices were USG and MRE. USG is more effective for osteo-mobilization type and MRE device for minimally invasive osteo-condensation.
PubMed: 38273919
DOI: 10.4103/njms.njms_423_21 -
The Journal of Prosthetic Dentistry Nov 2023Standard-diameter dental implants are not always applicable because of anatomic limitations of the residual ridge. Thus, mini-implants have been increasingly used and... (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
Standard-diameter dental implants are not always applicable because of anatomic limitations of the residual ridge. Thus, mini-implants have been increasingly used and offer an alternative. However, data regarding prosthetic complications, maintenance factors, and clinical outcomes are limited.
PURPOSE
The purpose of this systematic review and meta-analysis was to compare prosthetic complications and maintenance events and clinical outcomes in residual ridges rehabilitated with mandibular implant overdentures (IODs) by using standard implants or mini-implants.
MATERIAL AND METHODS
Nine electronic databases were searched. Quantitative analyses to measure the risk ratio (RR) and standardized mean difference (SMD) were applied. Those methods were used to assess prosthetic complications and maintenance events (abutment adjustments, replacement of retentive element, occlusal adjustment, and overdenture fracture) and clinical outcomes related to postoperative pain, probing depth (PD), plaque index (PI), marginal bone loss (MBL), and implant survival rate.
RESULTS
Altogether, 7 publications were selected. Mini-implants presented reduced abutment adjustments (RR 0.23 [0.07, 0.73], P=.01), replacement of retentive element (RR 0.41 [0.31, 0.54], P<.001), occlusal adjustment (RR 0.53 [0.31, 0.91], P=.02), and overdenture fracture (RR 0.46 [0.23, 0.94], P=.03) compared with standard implants. Additionally, mini-implants presented lower values for PI at 6 months (SMD -0.27 [-0.47, -0.08], P=.006) and 12 months (SMD -0.25 [-0.46, -0.05], P=.01). No additional tangible differences were noted.
CONCLUSIONS
Mini-implants might be an alternative choice based on the number of prosthetic complications and maintenance events. This was also confirmed by the comparable clinical data between standard implants and mini-implants.
Topics: Humans; Dental Implants; Denture, Overlay; Dental Prosthesis, Implant-Supported; Alveolar Bone Loss; Mandible
PubMed: 35120735
DOI: 10.1016/j.prosdent.2021.11.010 -
Clinical Oral Implants Research Jun 2024The aim of this systematic review and meta-analyses was to evaluate the outcomes of alveolar ridge preservation (ARP) following extraction of non-molar teeth in... (Review)
Review
OBJECTIVES
The aim of this systematic review and meta-analyses was to evaluate the outcomes of alveolar ridge preservation (ARP) following extraction of non-molar teeth in comparison to early implant placement (EIP) in terms of clinical and radiographic changes, need for additional augmentation at the time of implant placement, patient-reported outcomes, and implant failure rate.
METHODS
Electronic databases were searched to identify randomized and non-randomized studies that compared ARP to EIP. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analyzed using a statistical software program.
RESULTS
A total of 106 studies were identified, of which five studies with 198 non-molar extraction sockets in 198 participants were included. Overall meta-analysis showed significant differences in changes in midfacial mucosal margin (mean difference (MD) -0.09; 95% confidence interval (CI) -0.17 to -0.01; p = .03) and ridge width (MD -1.70; 95% CI -3.19 to -0.20; p = .03) in favor of ARP. The use of ARP was also associated with less need for additional augmentation at implant placement, but the difference was not statistically significant.
CONCLUSIONS
Within the limitation of this review, ARP following extraction of non-molar teeth has short-term positive effects on soft tissue contour, mucosal margin and thickness, and alveolar ridge width and height. It can also simplify future implant treatment by minimizing the need for additional augmentation.
PubMed: 38850092
DOI: 10.1111/clr.14314 -
Clinical Oral Investigations Dec 2023To assess whether in animals or patients with ≥ 1 tooth extracted, hyaluronic acid (HyA) application results in superior healing and/or improved complication... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To assess whether in animals or patients with ≥ 1 tooth extracted, hyaluronic acid (HyA) application results in superior healing and/or improved complication management compared to any other treatment or no treatment.
MATERIALS AND METHODS
Three databases were searched until April 2022. The most relevant eligibility criteria were (1) local application of HyA as adjunct to tooth extraction or as treatment of alveolar osteitis, and (2) reporting of clinical, radiographic, histological, or patient-reported data. New bone formation and/or quality were considered main outcome parameters in preclinical studies, while pain, swelling, and trismus were defined as main outcome parameters in clinical studies.
RESULTS
Five preclinical and 22 clinical studies (1062 patients at final evaluation) were included. In preclinical trials, HyA was applied into the extraction socket. Although a positive effect of HyA was seen in all individual studies on bone formation, this effect was not confirmed by meta-analysis. In clinical studies, HyA was applied into the extraction socket or used as spray or mouthwash. HyA application after non-surgical extraction of normally erupted teeth may have a positive effect on soft tissue healing. Based on meta-analyses, HyA application after surgical removal of lower third molars (LM3) resulted in significant reduction in pain perception 7 days postoperatively compared to either no additional wound manipulation or the application of a placebo/carrier. Early post-operative pain, trismus, and extent of swelling were unaffected.
CONCLUSIONS
HyA application may have a positive effect in pain reduction after LM3 removal, but not after extraction of normally erupted teeth.
CLINICAL RELEVANCE
HyA application may have a positive effect in pain reduction after surgical LM3 removal, but it does not seem to have any impact on other complications or after extraction of normally erupted teeth. Furthermore, it seems not to reduce post-extraction alveolar ridge modeling, even though preclinical studies show enhanced bone formation.
Topics: Humans; Animals; Tooth Socket; Hyaluronic Acid; Trismus; Dry Socket; Tooth Extraction; Molar, Third; Pain
PubMed: 37963982
DOI: 10.1007/s00784-023-05227-4 -
Journal of Clinical Medicine Feb 2024To investigate the efficacy of alveolar ridge preservation (ARP) in periodontally compromised molar extraction sites. (Review)
Review
AIM
To investigate the efficacy of alveolar ridge preservation (ARP) in periodontally compromised molar extraction sites.
METHODS
An electronic search was performed on 10th November 2023 across five databases, seeking randomised/non-randomised controlled trials (RCTs/NCTs) that included a minimum follow-up duration of four months. The RoB2 and Robins-I tools assessed the risk of bias for the included studies. Data on alveolar ridge dimensional and volumetric changes, keratinized mucosal width, and need for additional bone augmentation for implant placement were collected. Subsequently, a meta-analysis was carried out to derive the pooled estimates.
RESULTS
Six studies were incorporated in the present review, and a total of 135 molar extraction sockets in 130 subjects were included in the meta-analysis. ARP was undertaken in 68 sites, and 67 sites healed spontaneously. The follow-up time ranged from 4 to 6 months. The meta-analysis of both RCTs and NCTs showed significant differences in mid-buccal ridge width changes at 1 mm level below ridge crest with a mean difference (MD) of 3.80 (95% CI: 1.67-5.94), mid-buccal ridge height changes (MD: 2.18; 95% CI: 1.25-3.12) and volumetric changes (MD: 263.59; 95% CI: 138.44-388.74) in favour of ARP, while the certainty of evidence is graded low to very low. Moreover, ARP appeared to reduce the need for additional sinus and bone augmentation procedures at implant placement with low certainty of evidence.
CONCLUSIONS
Within the limitations of this study, alveolar ridge preservation in periodontally compromised extraction sites may, to some extent, preserve the ridge vertically and horizontally with reference to spontaneous healing. However, it could not eliminate the need for additional augmentation for implant placement. Further, longitudinal studies with large sample sizes and refined protocols are needed.
PubMed: 38592010
DOI: 10.3390/jcm13051198