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Periodontology 2000 Feb 2024Platelet-rich fibrin (PRF) has been characterized as a regenerative biomaterial that is fully resorbed within a typical 2-3 week period. Very recently, however, a...
Platelet-rich fibrin (PRF) has been characterized as a regenerative biomaterial that is fully resorbed within a typical 2-3 week period. Very recently, however, a novel heating process was shown to extend the working properties of PRP/PRF from a standard 2-3 week period toward a duration of 4-6 months. Numerous clinicians have now utilized this extended-PRF (e-PRF) membrane as a substitute for collagen barrier membranes in various clinical applications, such as guided tissue/bone regeneration. This review article summarizes the scientific work to date on this novel technology, including its current and future applications in periodontology, implant dentistry, orthopedics and facial aesthetics. A systematic review was conducted investigating key terms including "Bio-Heat," "albumin gel," "albumin-PRF," "Alb-PRF," "extended-PRF," "e-PRF," "activated plasma albumin gel," and "APAG" by searching databases such as MEDLINE, EMBASE and PubMed. Findings from preclinical studies demonstrate that following a simple 10-min heating process, the transformation of the liquid plasma albumin layer into a gel-like injectable albumin gel extends the resorption properties to at least 4 months according to ISO standard 10 993 (subcutaneous animal model). Several clinical studies have now demonstrated the use of e-PRF membranes as a replacement for collagen membranes in GTR/GBR procedures, closing lateral windows in sinus grafting procedures, for extraction site management, and as a stable biological membrane during recession coverage procedures. Furthermore, Alb-PRF may also be injected as a regenerative biological filler that lasts extended periods with advantages in joint injections, osteoarthritis and in the field of facial aesthetics. This article highlights the marked improvement in the stability and degradation properties of the novel Alb-PRF/e-PRF technology with its widespread future potential use as a potential replacement for collagen membranes with indications including extraction site management, GBR procedures, lateral sinus window closure, recession coverage among others, and further highlights its use as a biological regenerative filler for joint injections and facial aesthetics. It is hoped that this review will pioneer future opportunities and research development in the field, leading to further progression toward more natural and less costly biomaterials for use in medicine and dentistry.
Topics: Animals; Humans; Biocompatible Materials; Bone Regeneration; Guided Tissue Regeneration, Periodontal; Membranes, Artificial; Platelet-Rich Fibrin
PubMed: 37986559
DOI: 10.1111/prd.12537 -
The Journal of Prosthetic Dentistry Sep 2023High-level evidence concerning the restoration of endodontically treated posterior teeth by means of direct composite resin or indirect restorations is lacking. (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
High-level evidence concerning the restoration of endodontically treated posterior teeth by means of direct composite resin or indirect restorations is lacking.
PURPOSE
The purpose of this systematic review and meta-analysis was to analyze the current literature on the direct and indirect restoration of endodontically treated posterior teeth.
MATERIAL AND METHODS
Databases MEDLINE, CENTRAL, and EMBASE were screened. Risk of bias was assessed by using the ROB2 tool for RCTs and the ROBINS-I tool for prospective and retrospective clinical studies. Randomized clinical trials (RCTs) and prospective and retrospective studies comparing direct composite resin and indirect restorations on endodontically treated posterior teeth were included. Outcomes were tooth and restoration survival. A meta-analysis was conducted for tooth retention and restorative success.
RESULTS
Twenty-two studies were included (2 RCTs, 3 prospective, and 17 retrospective). Over the short term (2.5 to 3 years), low-quality evidence suggested no difference in tooth survival. For the prospective and retrospective clinical trials, the overall risk of bias was serious to critical from the risk of confounding because of a difference in restorative indication: Direct restorations were fabricated when one marginal ridge remained or when tooth prognosis was unfavorable. For short-term restorative success, low-quality evidence suggested no difference between the direct and indirect restorations.
CONCLUSIONS
For the short term (2.5 to 3 years), low-quality evidence suggests no difference in tooth survival or restoration quality. To assess the influence of the type of restoration on the survival and restorative success of endodontically treated posterior teeth, clinical trials that control for the amount of coronal tooth tissue and other baseline characteristics are needed.
Topics: Humans; Composite Resins; Dental Restoration, Permanent; Molar; Retrospective Studies; Dental Restoration Failure; Tooth, Nonvital
PubMed: 34980474
DOI: 10.1016/j.prosdent.2021.11.009 -
International Journal of Implant... Jul 2023The purpose of this systematic review was to assess the evidence regarding the indications for placement of zygomatic implants to rehabilitate edentulous maxillae. (Review)
Review
PURPOSE
The purpose of this systematic review was to assess the evidence regarding the indications for placement of zygomatic implants to rehabilitate edentulous maxillae.
MATERIAL AND METHODS
A focused question using the PIO format was developed, questioning "in patients in need of an implant-supported rehabilitation of the edentulous maxillae, what are the indications for the use of zygomatic implants''. The primary information analyzed and collected was a clear description of the indication for the use of zygomatic implants.
RESULTS
A total of 1266 records were identified through database searching. The full-text review was conducted for 117 papers, and 10 were selected to be included in this review. Zygomatic implant indications were extreme bone atrophy or deficiency secondary to different factors. The quad zygoma concept (two zygomatic implants bilaterally placed and splinted) was applied to 107 patients, the classic zygoma concept (one zygomatic implant bilaterally placed and splinted to standard anterior implants) was used in 88 patients, and the unilateral concept (one zygomatic implant on one side, splinted with one or more conventional implants) was employed in 14 patients.
CONCLUSIONS
The main indication for the use of zygomatic implants was considered extreme maxillary bone atrophy, resulting from many factors. The clear definition of what was considered "extreme bone atrophy" is not uniquely defined in each paper. Further studies are needed to develop clear indications for zygomatic implants.
Topics: Humans; Dental Implants; Atrophy; Databases, Factual; Medicine; Mouth, Edentulous
PubMed: 37391575
DOI: 10.1186/s40729-023-00480-4 -
Journal of Esthetic and Restorative... Feb 2024To assess and compare, through a systematic review of the literature, the biomechanical performance of endocrowns and traditional core-crowns (with and without... (Review)
Review
OBJECTIVE
To assess and compare, through a systematic review of the literature, the biomechanical performance of endocrowns and traditional core-crowns (with and without intracanal post) for the rehabilitation of endodontically treated teeth with severe coronal structure damage.
MATERIALS AND METHODS
A systematic search was performed in MEDLINE/PubMed, Scopus, and Web of Science databases. In-vitro studies comparing endocrowns with (post-)core-crown restorations were selected and screened by two independent reviewers. The included studies were submitted to the risk of bias analysis using the RoBDEMAT tool and the biomechanical outcomes were collected for qualitative analysis. The extracted data were presented based on comparative analyses among the included studies.
RESULTS
Thirty-one studies were included: 9 studies evaluated restorations of molars, 14 for premolars, and 8 studies evaluated anterior restorations. For the majority of the studies, endocrowns showed either similar or greater survival rates under fatigue and monotonic load than (post-)core-crown restorations, irrespectively of the tooth. The endocrowns showed more favorable failure patterns than (post-)core-crowns, irrespectively of the tooth. Endocrowns produced lower stresses in the restorative material for molars and premolars and in the luting material for premolars than (post-)core-crown restorations. The included studies presented adequate information for most items of the RoBDEMAT risk of bias tool.
CONCLUSION
Endocrowns showed similar or greater biomechanical performance than the traditional (post-)core-crown restorations in most of the evaluated studies.
CLINICAL SIGNIFICANCE
This systematic review showed that endocrowns present either similar or greater biomechanical performance than core-crown restorations for anterior and posterior endodontically treated teeth with severe structural damage.
Topics: Humans; Crowns; Dental Materials; Dental Restoration Failure; Dental Stress Analysis; Materials Testing; Tooth, Nonvital; Prosthodontics
PubMed: 37571973
DOI: 10.1111/jerd.13119 -
Clinical Oral Implants Research Sep 2023To review the available literature on the medium- and long-term effects of soft tissue augmentation (STA) at implant sites and to explore the effects of the different... (Review)
Review
OBJECTIVES
To review the available literature on the medium- and long-term effects of soft tissue augmentation (STA) at implant sites and to explore the effects of the different approaches on clinical-, patient-reported, and health-related parameters.
MATERIALS AND METHODS
A comprehensive electronic and manual search was performed to identify prospective clinical studies that assessed the medium- and long-term (≥36 months) outcomes following STA, including number of sites maintaining peri-implant health and number of sites developing peri-implant disease, incidence of complications, stability of the clinical, volumetric, and radiographic parameters, and patient-reported outcome measures (PROMs).
RESULTS
Fifteen studies were included in the qualitative analysis. STA was performed with either a bilaminar- or an apically positioned flap (APF) approach, in combination with autogenous grafts (free gingival graft [FGG] and connective tissue graft [CTG]) or substitutes (acellular dermal matrix [ADM] and xenogeneic cross-linked collagen matrix [CCM]). An overall high survival rate was observed. Most of the augmented implant sites maintained peri-implant health in the medium and long term, with the incidence of peri-implant mucositis and peri-implantitis ranging from 0% to 50% and from 0% to 7.14%, respectively. The position of the soft tissue margin following APF + FGG and bilaminar approaches involving CTG or CCM was found to be stable over time. No substantial changes were reported for plaque score/index, bleeding on probing/bleeding index, and probing depth between early time points and following visits. CTG-based STA procedures resulted in a stable or increased dimension of keratinized mucosa width (KMW) and mucosal thickness (MT)/volumetric outcomes over time, when compared with early follow-ups. Most of the included studies described stable marginal bone levels at the grafted implant sites over time. No substantial changes for patient-reported outcomes and professionally assessed esthetic results were reported at different time points.
CONCLUSIONS
Implants that received STA showed overall high survival rate and relatively low incidence of peri-implantitis in the medium and long term. Augmented sites seem to maintain the level of soft tissue margin and marginal bone over time, while non-augmented implants may exhibit apical shift of the soft tissue margin. The overall favorable early outcomes obtained with STA are maintained in the medium and long term, with an increase in KMW and MT that may be expected over time at CTG-augmented sites.
Topics: Humans; Peri-Implantitis; Prospective Studies; Dental Implants; Oral Surgical Procedures; Acellular Dermis
PubMed: 37750532
DOI: 10.1111/clr.14150 -
Clinical Oral Implants Research Sep 2023The aim of this study was to review available evidence for Type 1A (immediate implant placement and immediate loading) of single tooth replacement in the maxillary... (Meta-Analysis)
Meta-Analysis Review
Selection criteria for immediate implant placement and immediate loading for single tooth replacement in the maxillary esthetic zone: A systematic review and meta-analysis.
OBJECTIVES
The aim of this study was to review available evidence for Type 1A (immediate implant placement and immediate loading) of single tooth replacement in the maxillary esthetic zone.
MATERIALS AND METHODS
An electronic search was conducted utilizing the databases of MEDLINE, Embase, and Cochrane to identify publications reporting on the outcomes of Type 1A for single tooth replacement in the maxillary esthetic zone. The success and survival rates of the included articles were reported, which were further categorized according to the clinical criteria reported in Type 1A. Mean survival rates were univariately compared between risk groups and additionally between studies published before and since 2012 using bias-corrected and study size-weighed bootstrap tests. A study time-correcting meta-analysis was then performed to obtain an overall effect for the study pool.
RESULTS
A total of 3118 publications were identified in the search, with a total of 68 articles included. A mean number of implants per study were 37.2 and mean follow-up was 2.8 years. All the included studies utilizing Type 1A report highly selective inclusion and exclusion criteria. Univariate risk group comparison determined that studies before 2012 report a significantly lower mean survival rate (difference of -1.9 percentage points [PP], 95% CI: [-0.3, -4.0], p = .02), facial gap dimension had an impact on survival rates (+3.1 PP [0.2, 5.3] for width >2 mm, p = .04), as well as presence of endodontic infection (+2.6 PP [0.9, 5.1], p = .004).
CONCLUSIONS
Type 1A has a high survival rate in studies reporting strict patient and site selection criteria. Further research is required to assess esthetic and functional success with Type 1A treatments.
Topics: Humans; Patient Selection; Dental Implants; Esthetics, Dental; Databases, Factual
PubMed: 37750515
DOI: 10.1111/clr.14109 -
International Endodontic Journal Oct 2023In addition to non-surgical root canal treatment or retreatment, apical surgery may be carried out to manage teeth with apical periodontitis. However, it is unclear... (Review)
Review
BACKGROUND
In addition to non-surgical root canal treatment or retreatment, apical surgery may be carried out to manage teeth with apical periodontitis. However, it is unclear which treatment option is more effective.
OBJECTIVE
To systematically review the effectiveness of apical surgery compared with non-surgical treatment or retreatment in terms of clinical and patient-related outcomes in teeth with apical periodontitis.
METHODS
A literature search of electronic databases, the grey literature, the reference lists of included articles and previous reviews, and a hand search of leading endodontic journals, was conducted. Randomised and non-randomised control trials, and longitudinal observational studies on patients undergoing surgical (treatment group) and non-surgical root canal treatment or retreatment (control group) of teeth with apical periodontitis were included. The risk of bias was appraised using the Cochrane risk-of-bias tool; ROBINS-I and the Newcastle-Ottawa Scale.
RESULTS
Five studies, consisting of two randomised clinical trials, two non-randomised clinical trials, and a retrospective cohort study, were included. The interobserver agreement was high and kappa correlation coefficient was good. In total 529 teeth were available for follow-up that varied from 6 months to 8.7 years. The overall risk of bias was high for four studies and raised some concerns in one study. Apical surgery showed seemly better results regarding periapical healing and less need for more and further intervention, although tooth survival was higher in the control group. Given the heterogeneity of the studies, meta-analysis was not possible.
DISCUSSION
Previous systematic reviews have conducted an indirect comparison by separately pooling the outcomes of studies analysing either non-surgical, or surgical, treatment. In this systematic review, only studies that compared both treatments were included. Most results of this and previous reviews were similar.
CONCLUSION
No treatment option showed clear superiority. However, to arrive at statistically supported conclusions there is a need for additional high-quality comparative trials.
REGISTRATION
PROSPERO database (Registration number CRD42021260300).
Topics: Humans; Clinical Trials as Topic; Dental Pulp Cavity; Periapical Periodontitis; Retreatment; Retrospective Studies; Root Canal Therapy
PubMed: 35762859
DOI: 10.1111/iej.13793 -
The Journal of Prosthetic Dentistry Apr 2024When restoring endodontically treated teeth, a post system is indicated to retain a core. Clinicians can choose from different post materials and types. However, the... (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
When restoring endodontically treated teeth, a post system is indicated to retain a core. Clinicians can choose from different post materials and types. However, the literature is inconclusive on the long-term clinical performance of available post systems.
PURPOSE
The purpose of this systematic review and meta-analysis was to analyze the survival and failure rates of endodontically treated teeth restored either with glass-fiber-reinforced or metal posts.
MATERIAL AND METHODS
The research question was formulated by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using the Population, Intervention, Comparison, Outcome, Study Type (PICOS) tool. Medline (PubMed), Embase, and Scopus searches complemented by manual search were performed for randomized controlled clinical trials with a follow-up of at least 2 years. Two independent authors performed screening and data extraction of the articles. Meta-analyses were performed with the RevMan software program. Homogeneity was checked by using chi and I tests, and random-effects meta-analyses were applied. Odds ratio and 95% confidence interval were calculated (α=.05). The publication bias was evaluated by using funnel plots and the Begg and Egger tests.
RESULTS
A total of 184 studies were retrieved through the electronic searches, and an additional 4 through the hand search. After title- and abstract-level exclusion, 23 studies remained for full-text analyses, of which 7 were selected for data extraction. Meta-analyses revealed an overall survival rate of 92.8% for endodontically treated teeth restored with glass-fiber-reinforced posts compared with 78.1% of those restored with metal posts. No statistically significant difference (P>.05) was found in the survival, success, or failure rates.
CONCLUSIONS
No statistically significant differences were found between the survival and failure rates of endodontically treated teeth restored either with glass-fiber-reinforced or metal posts. The overall survival rate was 92.8% for glass fiber posts and 78.1% for metal posts. Both are reliable materials when a significant amount of coronal tooth structure is missing and treatment with a post is indicated.
Topics: Humans; Post and Core Technique; Tooth, Nonvital; Survival Rate; Glass; Metals; Tooth Fractures; Composite Resins
PubMed: 35430048
DOI: 10.1016/j.prosdent.2022.01.003 -
Medicina Oral, Patologia Oral Y Cirugia... Jul 2023The aim was to assess periodontal health maintenance and gingival recessions development in patients undergoing an orthodontic treatment with clear aligners (CA) and... (Meta-Analysis)
Meta-Analysis
Assessment of the periodontal health status and gingival recession during orthodontic treatment with clear aligners and fixed appliances: A systematic review and meta-analysis.
BACKGROUND
The aim was to assess periodontal health maintenance and gingival recessions development in patients undergoing an orthodontic treatment with clear aligners (CA) and fixed appliances (FA).
MATERIAL AND METHODS
An electronic search in MEDLINE, Scopus, The Cochrane Library, and Web of Science was performed up to September 2022 to identify all potential articles. Two investigators independently selected the studies according to the inclusion criteria. Prospective and retrospective studies assessing the periodontal health status and gingival recession development during the orthodontic treatment with buccal FA and CA were included. Case series, cross-sectional studies, and studies with less than two months of follow-up were excluded. Two investigators independently extracted the data from included articles and assessed risk of bias across studies using the Cochrane Collaboration tool. Qualitative and quantitative analyses of the data were performed. Pairwise meta-analysis using a random-effects model were used to compare periodontal indices between FA and CA treatment in different follow-up periods.
RESULTS
From the 129 potential studies, finally 12 studies were included. Only 8 could be included in the quantitative analysis. CA seems to slightly maintain better periodontal health indices. Only plaque index in a mid-term follow-up (mean difference (MD): -0.99; 95%; Confidence interval (CI) [-1.94 to -0.03]; P=.04; I2=99%), and pocket probing depth at a long-term follow-up (MD: -0.93mm; 95% CI [-1.16 to 0.7]; P<0.0001) reported statistically significant results favoring CA.
CONCLUSIONS
Up to the date there is not enough evidence to conclude that CA maintains better periodontal health during an orthodontic treatment than FA.
Topics: Humans; Gingival Recession; Prospective Studies; Cross-Sectional Studies; Retrospective Studies; Orthodontic Appliances, Fixed; Orthodontic Appliances, Removable; Orthodontic Appliances
PubMed: 36641738
DOI: 10.4317/medoral.25760 -
BMC Oral Health Aug 2023Large cavity designs and access cavities impair endodontically treated tooth fracture resistance. As the tooth's strength is known to reduce significantly after the root...
BACKGROUND
Large cavity designs and access cavities impair endodontically treated tooth fracture resistance. As the tooth's strength is known to reduce significantly after the root canal treatment, occlusal loading as a result of functions such as chewing, biting and certain parafunctional tendencies makes the endodontically treated tooth vulnerable to fracture. Hence, after endodontic treatment, it is vital to give adequate and appropriate restorative material to avoid tooth fractures. Accordingly, the choice of such restorative material should be dictated by the property of fracture resistance.
OBJECTIVE
The goal of this study was to conduct a systematic review and critical analysis of available data from in vitro studies examining the fracture resistance of endodontically treated posterior teeth restored with fiber-reinforced composites.
METHODOLOGY
The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRIS-MA) Statement was used to guide the reporting of this systematic review A comprehensive literature search was performed using MEDLINE (via PubMed), Scopus, ScienceDirect, Google Scholar, and LILACS. A manual search of the reference lists of the articles was also performed. The databases provided a total of 796 studies from the electronic systematic search. The databases provided a total of 796 studies from the electronic systematic search. Two reviewers scrutinized the papers for eligibility based on inclusion/exclusion criteria and extracted data. The studies were assessed for their potential risk of bias. Based on modified JBI & CRIS (checklist for reporting in vitro studies) guidelines, along with the methodology and treatment objective, we have formulated 13 parameters specifically to assess the risk of bias. A total of 18 studies met the inclusion criteria and were included for qualitative analysis. Considering the high heterogeneity of the studies included, a meta-analysis could not be performed.
RESULTS
The majority of the included studies had a moderate or high risk of bias. When compared to traditional hybrid composites, fiber-reinforced composites showed increased fracture resistance of endodontically treated teeth in the majority of investigations. On the other hand, limited evidence was found for the bulk fill composites. Moreover, moderate evidence was found for the fracture resistance of inlays and fiber posts with fiber-reinforced composites for core build-up in endodontically treated teeth. No evidence could be found comparing the fracture resistance of endo crowns and fiber-reinforced composites in endodontically treated teeth.
CONCLUSION
According to the research, using fiber-reinforced composites instead of conventional hybrid composites improves the fracture resistance of endodontically treated teeth. However, there was a high risk of bias in the research considered. No judgments could be reached about the superiority of one material over another based-on comparisons between other core restorations.
Topics: Humans; Tooth, Nonvital; Dental Materials; Crowns; Tooth Fractures; Composite Resins; Dental Stress Analysis
PubMed: 37574536
DOI: 10.1186/s12903-023-03217-2