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Journal of Esthetic and Restorative... Dec 2021Immediate implant placement with socket shield technique (SST) may maintain the buccal bone plate and soft tissue levels, however, the potential clinical benefits of SST... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Immediate implant placement with socket shield technique (SST) may maintain the buccal bone plate and soft tissue levels, however, the potential clinical benefits of SST lack strong scientific evidence. The aim of this systematic review and meta-analysis was to evaluate the effects of SST on dimensional changes of hard tissues, esthetic outcomes, implant stability, complication, and implant failure rates.
METHODS
Electronic databases were searched to identify randomized controlled trials (RCTs) that compared immediate implant placement with and without SST. 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 982 studies were identified, of which, seven RCTs with 206 immediately placed dental implants in 191 participants were included. Overall meta-analysis showed significant differences in the changes in buccal bone plate width (mean difference (MD) -0.22; 95% confidence interval (CI) -0.30 to -0.15; p < 0.0001) and height (MD -0.52; 95% CI -0.85 to -0.18; p = 0.002) in favor of SST. The use of SST was also associated with significantly less changes in peri-implant marginal bone levels and better pink esthetic score than immediately placing implants without SST. The differences in implant stability, complication and implant failure rates were not statistically significant between immediate implant placement with or without SST.
CONCLUSIONS
The short-term complication and implant failure rates following immediate implant placement with or without SST were comparable. The SST has short-term positive effects on the changes in width and height of buccal bone plate, peri-implant marginal bone levels and esthetic outcomes. Further evidence from long-term RCTs are still required to substantiate the current findings.
CLINICAL SIGNIFICANCE
SST can reduce changes in buccal plate width and height and improve the soft tissue profile following immediate implant placement in esthetic zone.
Topics: Dental Implantation, Endosseous; Dental Implants; Dental Implants, Single-Tooth; Esthetics, Dental; Humans; Immediate Dental Implant Loading; Tooth Extraction; Tooth Socket
PubMed: 34380176
DOI: 10.1111/jerd.12812 -
Journal of Cranio-maxillo-facial... Oct 2021This systematic review and meta-analysis aimed to assess the effectiveness of a warm saline mouth bath (WSMB) in preventing dry socket after tooth extractions. A... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis aimed to assess the effectiveness of a warm saline mouth bath (WSMB) in preventing dry socket after tooth extractions. A systematic search for randomized controlled trials published until August 30, 2020, in seven databases was conducted: Cochrane, PubMed, Ovid Medline, Google Scholar, and OpenGrey databases, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry. The inclusion criteria were studies investigating the use of a warm saline mouth bath postoperatively in a population of participants who had a tooth extraction, compared to no mouth rinse at all/any other mouth rinse. The primary outcome assessed in the studies was the incidence of alveolar osteitis. Only eight randomized studies met all inclusion criteria and were selected for qualitative analysis. Six of the studies compared WSMB with antimicrobial rinses, and two studies compared WSMB with no-rinse. This review found no significant difference (P > 0.05) in the incidence of alveolar osteitis between WSMB and other antimicrobial rinses. Based on the results of this review, WSMB has potential in reducing post-operative complications such as alveolar osteitis following a routine or surgical extraction of teeth. However, more studies are needed to validate these findings, as most of the studies reviewed had a high level of bias.
Topics: Dry Socket; Humans; Mouthwashes; Postoperative Complications; Saline Solution; Tooth Extraction
PubMed: 34509363
DOI: 10.1016/j.jcms.2021.09.001 -
International Journal of Oral and... Mar 2021The purpose of this study was to estimate the effect of platelet-rich fibrin (PRF) on the control of alveolar osteitis (AO), pain, trismus, soft tissue healing, and... (Meta-Analysis)
Meta-Analysis Review
Effect of platelet-rich fibrin on the control of alveolar osteitis, pain, trismus, soft tissue healing, and swelling following mandibular third molar surgery: an updated systematic review and meta-analysis.
The purpose of this study was to estimate the effect of platelet-rich fibrin (PRF) on the control of alveolar osteitis (AO), pain, trismus, soft tissue healing, and swelling following mandibular third molar surgery. A comprehensive search of the literature was conducted through PubMed, Embase, Web of Science, and Cochrane Library up to May 2019. Randomized controlled studies conforming to the inclusion criteria were included. The record screening and data extraction were conducted by two authors independently. The risk of bias assessment was performed according to the guidelines recommended by the Cochrane Collaboration. The quantitative analysis was performed using RevMan version 5.3. Nineteen studies were included in the systematic review and 17 studies were eligible for the meta-analysis. The use of PRF significantly reduced the incidence of AO and postoperative pain when compared to the controls (AO: relative risk 0.43, 95% confidence interval (CI) 0.28 to 0.65, Z=3.90, P<0.0001 (I=0%); pain: day 1, standardized mean difference (SMD) -1.12, 95% CI -1.87 to -0.37, Z=2.93, P=0.003 (I=95%); day 3, SMD -0.93, 95% CI -1.48 to -0.38, Z=3.30, P=0.001 (I=92%); day 7, SMD -1.84, 95% CI -2.98 to -0.71, Z=3.19, P=0.001 (I=97%)). Additionally, the result showed a better soft tissue healing when PRF was used (mean difference -0.63, 95% CI -1.08 to -0.18, Z=2.76, P=0.006 (I=90%)). The use of PRF reduced the incidence of AO and postoperative pain following third molar surgery. Furthermore, PRF may also improve the postoperative soft tissue healing.
Topics: Dry Socket; Humans; Molar, Third; Pain, Postoperative; Platelet-Rich Fibrin; Tooth Extraction; Tooth, Impacted; Trismus
PubMed: 32950350
DOI: 10.1016/j.ijom.2020.08.014 -
Nutrients Jan 2020Several factors affect dental implant osseointegration, including surgical issues, bone quality and quantity, and host-related factors, such as patients' nutritional...
Several factors affect dental implant osseointegration, including surgical issues, bone quality and quantity, and host-related factors, such as patients' nutritional status. Many micronutrients might play a key role in dental implant osseointegration by influencing some alveolar bone parameters, such as healing of the alveolus after tooth extraction. This scoping review aims to summarize the role of dietary supplements in optimizing osseointegration after implant insertion surgery. A technical expert panel (TEP) of 11 medical specialists with expertise in oral surgery, bone metabolism, nutrition, and orthopedic surgery performed the review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) model. The TEP identified micronutrients from the "European Union (EU) Register of nutrition and health claims made on foods" that have a relationship with bone and tooth health, and planned a PubMed search, selecting micronutrients previously identified as MeSH (Medical Subject Headings) terms and adding to each of them the words "dental implants" and "osseointegration". The TEP identified 19 studies concerning vitamin D, magnesium, resveratrol, vitamin C, a mixture of calcium, magnesium, zinc, and vitamin D, and synthetic bone mineral. However, several micronutrients are non-authorized by the "EU Register on nutrition and health claims" for improving bone and/or tooth health. Our scoping review suggests a limited role of nutraceuticals in promoting osseointegration of dental implants, although, in some cases, such as for vitamin D deficiency, there is a clear link among their deficit, reduced osseointegration, and early implant failure, thus requiring an adequate supplementation.
Topics: Animals; Bone-Anchored Prosthesis; Dental Implantation, Endosseous; Dental Implants; Dietary Supplements; Humans; Nutritional Status; Osseointegration; Prosthesis Design; Treatment Outcome
PubMed: 31968626
DOI: 10.3390/nu12010268 -
Journal of Oral & Maxillofacial Research 2019To evaluate the reported literature on the use of stem cells or growth factors for post extraction treatment of the alveolar bone. (Review)
Review
OBJECTIVES
To evaluate the reported literature on the use of stem cells or growth factors for post extraction treatment of the alveolar bone.
MATERIAL AND METHODS
A NCBI PubMed and PubMed Central databases search was conducted between September 2010 and August 2018, to identify animal or clinical studies reporting the clinical, radiographical and/or histological outcomes of socket preservation techniques after applying mesenchymal stem cells or growth factors. Only studies published in English language in the last 10 years were included in the study.
RESULTS
Eleven studies were identified fulfilling the inclusion criteria. They evaluate a total of 386 post extraction sockets. The main tested materials identified in the current review were bone morphogenetic protein-2 - 3 studies and mesenchymal stem cells - 3 studies. Other comparators were bone morphogenetic protein-9, platelet-derived growth factor-BB homodimers and bone marrow. Overall evaluation indicate positive results for all test groups showing differences in final socket width between 0.64 and 1.28 mm favouring the test groups. Histologically, no particular differences are detected between test and control groups. Most of the studies present low risk of bias.
CONCLUSIONS
In general, the use of mesenchymal stem cells or bioactive osteogenic molecules favours bone regeneration after tooth extraction, as evaluated clinically, radiographically and histologically. However, specific differences that support particular recommendations are still unclear in light of the current published evidence. Future studies should include the standardization of the mesenchymal stem cells selection and purification as well as dosage and delivery methods of bioactive molecules.
PubMed: 31620269
DOI: 10.5037/jomr.2019.10307 -
The Journal of Contemporary Dental... Feb 2022The present systematic review and meta-analysis (SR/MA) aimed to test the null hypothesis that there is no difference between socket-shield technique (SST) and... (Meta-Analysis)
Meta-Analysis
AIM
The present systematic review and meta-analysis (SR/MA) aimed to test the null hypothesis that there is no difference between socket-shield technique (SST) and conventional immediate implant placement (CIIP) as an esthetic rehabilitation option for permanent human anterior teeth, against the alternative one of a difference.
BACKGROUND
Socket-shield technique is considered as a highly promising procedure that has the potential to prevent resorption of anterior alveolar ridges, maintains white and pink esthetics, and provides a solution for esthetically critical cases. Controlled randomized clinical trials (RCT) and nonrandomized ones had been identified by searching the following databases: Google Scholar, Scopus, and PubMed. Literature search was determined from January 2010 up to June 2020. Hand searches were also accomplished for relevant abstracts, books, and reference lists. The eligibility criteria included prospective observational controlled RCTs and non-RCTs.
POPULATIONS
patients with endodontically treated/nonrestorable permanent mature anterior teeth indicated for extraction.
INTERVENTIONS
the sockets were subjected to immediate implant placement using SST.
CONTROLS
implants placed with SST compared with those of CIIP.
OUTCOME
the pink esthetic score measured for esthetic rehabilitation. To assess article quality, the Cochrane risk-of-bias tool was used by two independent authors. The data across quantitative studies were analyzed using comprehensive MA software.
REVIEW RESULTS
The initial search found out 172 references through the search strategy and three additional ones were recognized through hand searching. After being filtered, 101 references were screened and recorded. After the inclusion and exclusion criteria were applied, only seven unduplicated prospective controlled RCTs and non-RCTs were involved in the quantitative MA. At the 6-month evaluation period, the total standard difference in mean was 1.07 and test value measuring heterogeneity was 77.182, whereas at the 12-month period, the total standard difference in mean was 1.43 and test value measuring heterogeneity was 64.914.
CONCLUSION
SST had a positive effect on the esthetic rehabilitation for anterior teeth better than CIIP. However, this conclusion was dependent on a very few well-conducted prospective RCT and non-RCT. Further RCTs with longer observational time, proper methodology, and of larger sample size are still required to adequately answer the question of the present SR.
CLINICAL SIGNIFICANCE
There is limited knowledge about the appropriateness of SST in the field of implant dentistry, specifically for esthetic consideration. This SR/MA confirmed the positive effect of the SST over CIIP for esthetic rehabilitation for anterior teeth.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier CRD42020194086.
Topics: Dental Implantation, Endosseous; Dental Implants, Single-Tooth; Esthetics, Dental; Humans; Immediate Dental Implant Loading; Observational Studies as Topic; Tooth Extraction; Tooth Socket; Treatment Outcome
PubMed: 35748456
DOI: No ID Found -
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 -
Clinical Oral Implants Research Sep 2022Alveolar ridge preservation (ARP) procedures can limit bone changes following tooth extraction. However, the role of ARP in periodontally compromised socket lacks strong... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Alveolar ridge preservation (ARP) procedures can limit bone changes following tooth extraction. However, the role of ARP in periodontally compromised socket lacks strong scientific evidence. The aim of this systematic review and meta-analysis was to evaluate the outcomes of ARP following extraction of periodontally compromised teeth in comparison with extraction alone in terms of hard tissue changes, need for additional augmentation at the time of implant placement, and patient-reported outcomes.
MATERIAL AND METHODS
Electronic databases were searched to identify randomized controlled trials (RCTs) that compared ARP in periodontally compromised sockets with spontaneous socket healing. The risk of bias was assessed using the Cochrane Collaboration's risk of bias tool.
RESULTS
Five studies with 134 extraction sockets in 126 participants were included. Of these, ARP was performed in 77 sites, while the remaining sites were intentionally left to heal without any ARP treatment. The follow-up time varied between 6 and 12 months. Overall meta-analysis showed significant differences in changes in ridge height (mean difference (MD) -0.95; 95% confidence interval (CI) -1.43 to -0.47; p = .0001) and bone volume (MD -38.70; 95% CI -52.17 to -25.24; p < .0001) in favor of ARP. The use of ARP following extraction of periodontally compromised tooth was also associated with significantly less need for additional bone grafting at the time of implant placement.
CONCLUSIONS
Within the limitation of this review, ARP following extraction of periodontally compromised teeth may have short-term positive effects on alveolar ridge height and bone volume and minimize the need for additional augmentation procedures. However, the evidence is of very low to low certainty.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Bone Transplantation; Humans; Tooth Extraction; Tooth Socket
PubMed: 35818637
DOI: 10.1111/clr.13975 -
The International Journal of Oral &... 2020This systematic review aimed to assess the effect of chlorhexidine (CHX) in preventing complications after extractive, implant, and periodontal surgery. (Meta-Analysis)
Meta-Analysis
PURPOSE
This systematic review aimed to assess the effect of chlorhexidine (CHX) in preventing complications after extractive, implant, and periodontal surgery.
MATERIALS AND METHODS
The PICO question set for this systematic review was: "Is the use of chlorhexidine formulations able to prevent complications (safety) in patients undergoing procedures of either oral surgery, dental implantology, or periodontology compared to treatment procedures in patients without a chlorhexidine prescription?" Once inclusion and exclusion criteria were established, a search was carried out independently by two researchers on PubMed/MEDLINE, Scopus, and Web of Science. The primary outcomes investigated were the rate of alveolar osteitis and bacteremia after surgical procedures in oral surgery. Meta-analysis and trial sequential analysis (TSA) were performed in order to evaluate the findings.
RESULTS
After the selection, the 32 studies that fully met the eligibility criteria were considered in this systematic review. A meta-analysis was only possible for data obtained from studies related to extractive surgery. Meta-analysis and TSA showed a statistically significant decrease in the rate of alveolar osteitis after tooth extraction when CHX was employed compared with placebo treatments or treatments not using CHX (RR = 0.49; 95% CI: [0.40, 0.60], P < .001; I = 8%). Focusing on the rate of bacteremia, meta-analysis and TSA showed how the employment of CHX (RR = 0.87; 95% CI: [0.79, 0.96], P = .004; I = 4%) decreases the rate of bacteremia after extractive surgery. Data from the literature seem to lack in the evaluation of CHX use for the reduction of complications in periodontology and implant dentistry.
CONCLUSION
This systematic review showed with a good power of evidence that CHX employment reduces alveolar osteitis and bacteremia rates after dental extractions.
Topics: Chlorhexidine; Dental Implants; Dry Socket; Humans
PubMed: 33270055
DOI: 10.11607/jomi.8216 -
Journal of Oral and Maxillofacial... Apr 2020The objective of the present systematic review was to compare the postoperative outcomes between envelope and triangular flaps after mandibular third molar surgery. (Meta-Analysis)
Meta-Analysis
PURPOSE
The objective of the present systematic review was to compare the postoperative outcomes between envelope and triangular flaps after mandibular third molar surgery.
MATERIALS AND METHODS
The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched from the inception date to November 2018. Randomized and nonrandomized controlled trials were included if they had met certain inclusion and exclusion criteria. The predictor variable was the flap design, envelope or triangular. The outcome variables were operation time, pain, trismus, alveolar osteitis (AO) incidence, wound dehiscence, and swelling. The methodologic quality assessment was performed in accordance with the Cochrane Collaboration guidelines. The meta-analysis was performed using Review Manager, version 5.2.
RESULTS
A total of 21 studies were included for qualitative synthesis, 18 of which were included in the meta-analysis. The use of envelope flaps required less operation time than triangular flaps (P < .00001; I = 9%). In the Pell and Gregory A and B subgroups, envelope flaps were associated with a significantly lower visual analog scale score at 3 (P = .05, I = 0%) and 7 (P = .02; I = 0%) postoperative days and with a greater postoperative interincisal distance at 7 postoperative days (P = .04; I = 0%). In contrast, envelope flaps were associated with a greater AO incidence in the subgroup of split-mouth randomized controlled trials (P = .001; I = 0%).
CONCLUSIONS
Envelope flaps required a shorter operation time than triangular flaps and were associated with less postoperative pain and trismus when applied to impacted mandibular third molars of Pell and Gregory Class A or B. In contrast, triangular flaps were associated with a decreased incidence of AO compared with envelope flaps.
Topics: Dry Socket; Humans; Mandible; Molar, Third; Pain, Postoperative; Postoperative Complications; Surgical Flaps; Tooth Extraction; Tooth, Impacted; Trismus
PubMed: 31883443
DOI: 10.1016/j.joms.2019.11.026