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Journal of Periodontology Jan 2021The peri-implant soft tissue phenotype (PSP) encompasses the keratinized mucosa width (KMW), mucosal thickness (MT), and supracrestal tissue height (STH). Numerous... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The peri-implant soft tissue phenotype (PSP) encompasses the keratinized mucosa width (KMW), mucosal thickness (MT), and supracrestal tissue height (STH). Numerous approaches to augment soft tissue volume around endosseous dental implants have been investigated. To what extent PSP modification is beneficial for peri-implant health has been subject of debate in the field of implant dentistry. The aim of this systematic review was to analyze the evidence regarding the efficacy of soft tissue augmentation procedures aimed at modifying the PSP and their impact on peri-implant health.
METHODS
A comprehensive search was performed to identify clinical studies that involved soft tissue augmentation around dental implants and reported findings on KMW, MT, and/or STH changes. The effect of the intervention on peri-implant health was also assessed. Selected articles were classified based on the general type of surgical approach to increase PSP, either bilaminar or an apically positioned flap (APF) technique. A network meta-analysis including only randomized-controlled trials (RCTs) reporting on PSP outcomes was conducted to assess and compare different techniques.
RESULTS
A total of 52 articles were included in the qualitative analysis, and 23 RCTs were included as part of the network meta-analysis. Sixteen RCTs reported the outcomes of PSP modification therapy with bilaminar techniques, whereas 7 involved the use of APF. The analysis showed that bilaminar techniques in combination with soft tissue grafts (connective tissue graft [CTG], collagen matrix [CM], and acellular dermal matrix [ADM]) resulted in a significant increase in MT compared to non-augmented sites. In particular, CTG and ADM were associated with higher MT gain as compared to CM and non-augmented sites. However, no significant differences in KMW were observed across different bilaminar techniques. PSP modification via a bilaminar approach utilizing either CTG or CM showed beneficial effects on marginal bone level stability. APF-based approaches in combination with free gingival graft (FGG), CTG, CM, or ADM showed a significant KMW gain compared to non-augmented sites. However, compared to APF alone, only FGG exhibited a significantly higher KMW gain. APF with any evaluated soft tissue graft was associated with with reduction of probing depth, soft tissue dehiscence and plaque index compared to non-augmented sites compared to non-augmented sites. The evidence regarding the effect of PSP modification via APF-based approaches on peri-implant marginal bone loss or preservation is inconclusive.
CONCLUSIONS
Bilaminar approach involving CTG or ADM obtained the highest amount of MT gain, whereas APF in combination with FGG was the most effective technique for increasing KMW. KMW augmentation via APF was associated with a significant reduction in probing depth, soft tissue dehiscence and plaque index, regardless of the soft tissue grafting material employed, whereas bilaminar techniques with CTG or CM showed beneficial effects on marginal bone level stability.
Topics: Connective Tissue; Dental Implants; Gingiva; Network Meta-Analysis; Phenotype
PubMed: 32710810
DOI: 10.1002/JPER.19-0716 -
International Journal of Implant... Jan 2022Dental implant surgery was developed to be the most suitable and comfortable instrument for dental and oral rehabilitation in the past decades, but with increasing... (Review)
Review
PURPOSE
Dental implant surgery was developed to be the most suitable and comfortable instrument for dental and oral rehabilitation in the past decades, but with increasing numbers of inserted implants, complications are becoming more common. Diabetes mellitus as well as prediabetic conditions represent a common and increasing health problem (International Diabetes Federation in IDF Diabetes Atlas, International Diabetes Federation, Brussels, 2019) with extensive harmful effects on the entire organism [(Abiko and Selimovic in Bosnian J Basic Med Sci 10:186-191, 2010), (Khader et al., in J Diabetes Complicat 20:59-68, 2006, https://doi.org/10.1016/j.jdiacomp.2005.05.006 )]. Hence, this study aimed to give an update on current literature on effects of prediabetes and diabetes mellitus on dental implant success.
METHODS
A systematic literature research based on the PRISMA statement was conducted to answer the PICO question "Do diabetic patients with dental implants have a higher complication rate in comparison to healthy controls?". We included 40 clinical studies and 16 publications of aggregated literature in this systematic review.
RESULTS
We conclude that patients with poorly controlled diabetes mellitus suffer more often from peri-implantitis, especially in the post-implantation time. Moreover, these patients show higher implant loss rates than healthy individuals in long term. Whereas, under controlled conditions success rates are similar. Perioperative anti-infective therapy, such as the supportive administration of antibiotics and chlorhexidine, is the standard nowadays as it seems to improve implant success. Only few studies regarding dental implants in patients with prediabetic conditions are available, indicating a possible negative effect on developing peri-implant diseases but no influence on implant survival.
CONCLUSION
Dental implant procedures represent a safe way of oral rehabilitation in patients with prediabetes or diabetes mellitus, as long as appropriate precautions can be adhered to. Accordingly, under controlled conditions there is still no contraindication for dental implant surgery in patients with diabetes mellitus or prediabetic conditions.
Topics: Chlorhexidine; Dental Implants; Diabetes Mellitus; Humans; Peri-Implantitis; Prediabetic State
PubMed: 34978649
DOI: 10.1186/s40729-021-00399-8 -
Medicina (Kaunas, Lithuania) Dec 2021: Tobacco is today the single most preventable cause of death, being associated with countless diseases, including cancer and neurological, cardiovascular, and... (Meta-Analysis)
Meta-Analysis Review
: Tobacco is today the single most preventable cause of death, being associated with countless diseases, including cancer and neurological, cardiovascular, and respiratory diseases. Smoking also brings negative consequences to oral health, potentially impairing treatment with dental implants. The present review aimed to evaluate the influence of smoking on dental implant failure rates and marginal bone loss (MBL). : Electronic search was undertaken in three databases, plus a manual search of journals. Meta-analyses were performed, in addition to meta-regressions, in order to verify how the odds ratio (OR) and MBL were associated with follow-up time. : The review included 292 publications. Altogether, there were 35,511 and 114,597 implants placed in smokers and in non-smokers, respectively. Pairwise meta-analysis showed that implants in smokers had a higher failure risk in comparison with non-smokers (OR 2.402, < 0.001). The difference in implant failure between the groups was statistically significant in the maxilla (OR 2.910, < 0.001), as well as in the mandible (OR 2.866, < 0.001). The MBL mean difference (MD) between the groups was 0.580 mm ( < 0.001). There was an estimated decrease of 0.001 in OR ( = 0.566) and increase of 0.004 mm ( = 0.279) in the MBL MD between groups for every additional month of follow-up, although without statistical significance. Therefore, there was no clear influence of the follow-up on the effect size (OR) and on MBL MD between groups. : Implants placed in smokers present a 140.2% higher risk of failure than implants placed in non-smokers.
Topics: Dental Implants; Humans; Mandible; Maxilla; Smokers; Smoking
PubMed: 35056347
DOI: 10.3390/medicina58010039 -
Periodontology 2000 Feb 2023Flapless and fully guided implant placement has the potential to maximize efficacy outcomes and at the same time to minimize surgical invasiveness. The aim of the... (Meta-Analysis)
Meta-Analysis Review
Flapless and fully guided implant placement has the potential to maximize efficacy outcomes and at the same time to minimize surgical invasiveness. The aim of the current systematic review was to answer the following PICO question: "In adult human subjects undergoing dental implant placement (P), is minimally invasive flapless computer-aided fully guided (either dynamic or static computer-aided implant placement (sCAIP)) (I) superior to flapped conventional (free-handed implant placement (FHIP) or cast-based/drill partially guided implant placement (dPGIP)) surgery (C), in terms of efficacy, patient morbidity, long-term prognosis, and costs (O)?" Randomized clinical trials (RCTs) fulfilling specific inclusion criteria established to answer the PICO question were included. Two review authors independently searched for eligible studies, screened the titles and abstracts, performed full-text analysis, extracted the data from the published reports, and performed the risk of bias assessment. In cases of disagreement, a third review author took the final decision during ad hoc consensus meetings. The study results were summarized using random effects meta-analyses, which were based (wherever possible) on individual patient data (IPD). A total of 10 manuscripts reporting on five RCTs, involving a total of 124 participants and 449 implants, and comparing flapless sCAIP with flapped FHIP/cast-based partially guided implant placement (cPGIP), were included. There was no RCT analyzing flapless dynamic computer-aided implant placement (dCAIP) or flapped dPGIP. Intergroup meta-analyses indicated less depth deviation (difference in means (MD) = -0.28 mm; 95% confidence interval (CI): -0.59 to 0.03; moderate certainty), angular deviation (MD = -3.88 degrees; 95% CI: -7.00 to -0.77; high certainty), coronal (MD = -0.6 mm; 95% CI: -1.21 to 0.01; low certainty) and apical (MD = -0.75 mm; 95% CI: -1.43 to -0.07; moderate certainty) three-dimensional bodily deviations, postoperative pain (MD = -17.09 mm on the visual analogue scale (VAS); 95% CI: -33.38 to -0.80; low certainty), postoperative swelling (MD = -6.59 mm on the VAS; 95% CI: -19.03 to 5.85; very low certainty), intraoperative discomfort (MD = -9.36 mm on the VAS; 95% CI: -17.10 to -1.61) and surgery duration (MD = -24.28 minutes; 95% CI: -28.62 to -19.95) in flapless sCAIP than in flapped FHIP/cPGIP. Despite being more accurate than flapped FHIP/cPGIP, flapless sCAIP still resulted in deviations with respect to the planned position (intragroup meta-analytic means: 0.76 mm in depth, 2.57 degrees in angular, 1.43 mm in coronal, and 1.68 in apical three-dimensional bodily position). Moreover, flapless sCAIP presented a 12% group-specific intraoperative complication rate, resulting in an inability to place the implant with this protocol in 7% of cases. Evidence regarding more clinically relevant outcomes of efficacy (implant survival and success, prosthetically and biologically correct positioning), long-term prognosis, and costs, is currently scarce. When the objective is to guarantee minimal invasiveness at implant placement, clinicians could consider the use of flapless sCAIP. A proper case selection and consideration of a safety margin are, however, suggested.
Topics: Adult; Humans; Dental Implants; Dental Implantation, Endosseous; Surgery, Computer-Assisted; Surgical Flaps
PubMed: 35906928
DOI: 10.1111/prd.12440 -
Frontiers in Cellular and Infection... 2021After insertion into the bone, implants osseointegrate, which is required for their long-term success. However, inflammation and infection around the implants may lead... (Review)
Review
INTRODUCTION
After insertion into the bone, implants osseointegrate, which is required for their long-term success. However, inflammation and infection around the implants may lead to implant failure leading to peri-implantitis and loss of supporting bone, which may eventually lead to failure of implant. Surface chemistry of the implant and lack of cleanliness on the part of the patient are related to peri-implantitis. The only way to get rid of this infection is decontamination of dental implants.
OBJECTIVE
This systematic review intended to study decontamination of microbial biofilm methods on titanium implant surfaces used in dentistry.
METHODS
The electronic databases Springer Link, Science Direct, and PubMed were explored from their inception until December 2020 to identify relevant studies. Studies included had to evaluate the efficiency of new strategies either to prevent formation of biofilm or to treat matured biofilm on dental implant surfaces.
RESULTS AND DISCUSSION
In this systematic review, 17 different groups of decontamination methods were summarized from 116 studies. The decontamination methods included coating materials, mechanical cleaning, laser treatment, photodynamic therapy, air polishing, anodizing treatment, radiation, sonication, thermal treatment, ultrasound treatment, chemical treatment, electrochemical treatment, antimicrobial drugs, argon treatment, and probiotics.
CONCLUSION
The findings suggest that most of the decontamination methods were effective in preventing the formation of biofilm and in decontaminating established biofilm on dental implants. This narrative review provides a summary of methods for future research in the development of new dental implants and decontamination techniques.
Topics: Anti-Infective Agents; Biofilms; Decontamination; Dental Implants; Humans; Peri-Implantitis
PubMed: 34692562
DOI: 10.3389/fcimb.2021.736186 -
Journal of Prosthodontic Research Jan 2022Dental implant therapy is a common clinical treatment for missing teeth. However, the esthetic result is not as satisfactory as expected in some cases, especially in the...
PURPOSE
Dental implant therapy is a common clinical treatment for missing teeth. However, the esthetic result is not as satisfactory as expected in some cases, especially in the anterior maxillary area. Poor esthetic results are caused by inadequate preparation of the hard and soft tissues in this area before treatment. The socket shield technique may be an alternative for a desirable esthetic outcome in dental implant treatments.
STUDY SELECTION
In the present systematic review, PubMed-Medline, Google Scholar, and ScienceDirect were searched for clinical studies published from January 2000 to December 2018.
RESULTS
Twenty studies were included, comprising one randomized controlled trial, two cohort studies, 14 clinical human case reports, and three retrospective case series. In total, 288 patients treated with the socket shield technique with immediate implant placement and follow-up between 3-60 months after placement were included. A quality assessment showed that 12 of the 20 included studies were of good quality. Twenty-six of the 274 (9.5%) cases developed complications or adverse effects related to the socket shield technique. Most studies reported implant survival without the complications (90.5%); most of the cases that were followed up for more than 12 months after implant placement achieved a good esthetic appearance. The failure rate was low without the complications, although there were some failures due to failed implant osseointegration, socket shield mobility and infection, socket shield exposure, socket shield migration, and apical root resorption.
CONCLUSIONS
The socket shield technique can be used in dental implant treatment, but it remains difficult to predict the long-term success of this technique until high-quality evidence becomes available.
Topics: Dental Implantation, Endosseous; Dental Implants; Dental Implants, Single-Tooth; Esthetics, Dental; Humans; Immediate Dental Implant Loading; Retrospective Studies; Tooth Extraction; Tooth Socket; Treatment Outcome
PubMed: 33692284
DOI: 10.2186/jpr.JPR_D_20_00054 -
The Journal of Prosthetic Dentistry Feb 2023Artificial intelligence (AI) applications are growing in dental implant procedures. The current expansion and performance of AI models in implant dentistry applications...
STATEMENT OF PROBLEM
Artificial intelligence (AI) applications are growing in dental implant procedures. The current expansion and performance of AI models in implant dentistry applications have not yet been systematically documented and analyzed.
PURPOSE
The purpose of this systematic review was to assess the performance of AI models in implant dentistry for implant type recognition, implant success prediction by using patient risk factors and ontology criteria, and implant design optimization combining finite element analysis (FEA) calculations and AI models.
MATERIAL AND METHODS
An electronic systematic review was completed in 5 databases: MEDLINE/PubMed, EMBASE, World of Science, Cochrane, and Scopus. A manual search was also conducted. Peer-reviewed studies that developed AI models for implant type recognition, implant success prediction, and implant design optimization were included. The search strategy included articles published until February 21, 2021. Two investigators independently evaluated the quality of the studies by applying the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Quasi-Experimental Studies (nonrandomized experimental studies). A third investigator was consulted to resolve lack of consensus.
RESULTS
Seventeen articles were included: 7 investigations analyzed AI models for implant type recognition, 7 studies included AI prediction models for implant success forecast, and 3 studies evaluated AI models for optimization of implant designs. The AI models developed to recognize implant type by using periapical and panoramic images obtained an overall accuracy outcome ranging from 93.8% to 98%. The models to predict osteointegration success or implant success by using different input data varied among the studies, ranging from 62.4% to 80.5%. Finally, the studies that developed AI models to optimize implant designs seem to agree on the applicability of AI models to improve the design of dental implants. This improvement includes minimizing the stress at the implant-bone interface by 36.6% compared with the finite element model; optimizing the implant design porosity, length, and diameter to improve the finite element calculations; or accurately determining the elastic modulus of the implant-bone interface.
CONCLUSIONS
AI models for implant type recognition, implant success prediction, and implant design optimization have demonstrated great potential but are still in development. Additional studies are indispensable to the further development and assessment of the clinical performance of AI models for those implant dentistry applications reviewed.
Topics: Humans; Artificial Intelligence; Dental Implantation, Endosseous; Dental Implants; Porosity
PubMed: 34144789
DOI: 10.1016/j.prosdent.2021.05.008 -
Journal of Clinical Periodontology Jun 2023This systematic review and meta-analysis aims to assess the efficacy of risk factor control to prevent the occurrence of peri-implant diseases (PIDs) in adult patients... (Meta-Analysis)
Meta-Analysis Review
AIM
This systematic review and meta-analysis aims to assess the efficacy of risk factor control to prevent the occurrence of peri-implant diseases (PIDs) in adult patients awaiting dental implant rehabilitation (primordial prevention) or in patients with dental implants surrounded by healthy peri-implant tissues (primary prevention).
MATERIALS AND METHODS
A literature search was performed without any time limit on different databases up to August 2022. Interventional and observational studies with at least 6 months of follow-up were considered. The occurrence of peri-implant mucositis and/or peri-implantitis was the primary outcome. Pooled data analyses were performed using random effect models according to the type of risk factor and outcome.
RESULTS
Overall, 48 studies were selected. None assessed the efficacy of primordial preventive interventions for PIDs. Indirect evidence on the primary prevention of PID indicated that diabetic patients with dental implants and good glycaemic control have a significantly lower risk of peri-implantitis (odds ratio [OR] = 0.16; 95% confidence interval [CI]: 0.03-0.96; I : 0%), and lower marginal bone level (MBL) changes (OR = -0.36 mm; 95% CI: -0.65 to -0.07; I : 95%) compared to diabetic patients with poor glycaemic control. Patients attending supportive periodontal/peri-implant care (SPC) regularly have a lower risk of overall PIDs (OR = 0.42; 95% CI: 0.24-0.75; I : 57%) and peri-implantitis compared to irregular attendees. The risk of dental implant failure (OR = 3.76; 95% CI: 1.50-9.45; I : 0%) appears to be greater under irregular or no SPC than regular SPC. Implants sites with augmented peri-implant keratinized mucosa (PIKM) show lower peri-implant inflammation (SMD = -1.18; 95% CI: -1.85 to -0.51; I : 69%) and lower MBL changes (MD = -0.25; 95% CI: -0.45 to -0.05; I : 62%) compared to dental implants with PIKM deficiency. Studies on smoking cessation and oral hygiene behaviors were inconclusive.
CONCLUSIONS
Within the limitations of available evidence, the present findings indicate that in patients with diabetes, glycaemic control should be promoted to avoid peri-implantitis development. The primary prevention of peri-implantitis should involve regular SPC. PIKM augmentation procedures, where a PIKM deficiency exists, may favour the control of peri-implant inflammation and the stability of MBL. Further studies are needed to assess the impact of smoking cessation and oral hygiene behaviours, as well as the implementation of standardized primordial and primary prevention protocols for PIDs.
Topics: Adult; Humans; Peri-Implantitis; Dental Implants; Stomatitis; Inflammation; Diabetes Mellitus; Primary Prevention
PubMed: 36807599
DOI: 10.1111/jcpe.13790 -
International Journal of Implant... Nov 2021To evaluate the efficacy of alternative or adjunctive measures to conventional non-surgical or surgical treatment of peri-implant mucositis and peri-implantitis. (Meta-Analysis)
Meta-Analysis Review
Efficacy of alternative or adjunctive measures to conventional non-surgical and surgical treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis.
PURPOSE
To evaluate the efficacy of alternative or adjunctive measures to conventional non-surgical or surgical treatment of peri-implant mucositis and peri-implantitis.
MATERIAL AND METHODS
Prospective randomized and nonrandomized controlled studies comparing alternative or adjunctive measures, and reporting on changes in bleeding scores (i.e., bleed0ing index (BI) or bleeding on probing (BOP)), probing depth (PD) values or suppuration (SUPP) were searched.
RESULTS
Peri-implant mucositis: adjunctive use of local antiseptics lead to greater PD reduction (weighted mean difference (WMD) = - 0.23 mm; p = 0.03, respectively), whereas changes in BOP were comparable (WMD = - 5.30%; p = 0.29). Non-surgical treatment of peri-implantitis: alternative measures for biofilm removal and systemic antibiotics yielded higher BOP reduction (WMD = - 28.09%; p = 0.01 and WMD = - 17.35%; p = 0.01, respectively). Surgical non-reconstructive peri-implantitis treatment: WMD in PD amounted to - 1.11 mm favoring adjunctive implantoplasty (p = 0.02). Adjunctive reconstructive measures lead to significantly higher radiographic bone defect fill/reduction (WMD = 56.46%; p = 0.01 and WMD = - 1.47 mm; p = 0.01), PD (- 0.51 mm; p = 0.01) and lower soft-tissue recession (WMD = - 0.63 mm; p = 0.01), while changes in BOP were not significant (WMD = - 11.11%; p = 0.11).
CONCLUSIONS
Alternative and adjunctive measures provided no beneficial effect in resolving peri-implant mucositis, while alternative measures were superior in reducing BOP values following non-surgical treatment of peri-implantitis. Adjunctive reconstructive measures were beneficial regarding radiographic bone-defect fill/reduction, PD reduction and lower soft-tissue recession, although they did not improve the resolution of mucosal inflammation.
Topics: Anti-Infective Agents, Local; Dental Implants; Humans; Mucositis; Peri-Implantitis; Prospective Studies
PubMed: 34779939
DOI: 10.1186/s40729-021-00388-x -
Clinical and Experimental Dental... Aug 2022The aim of this systematic review is to analyze literature regarding the relationship between the implant-abutment emergence angle (EA) and implant emergence profile... (Review)
Review
STATEMENT
The aim of this systematic review is to analyze literature regarding the relationship between the implant-abutment emergence angle (EA) and implant emergence profile (EP) and the prevalence of peri-implantitis.
METHODS
PubMed and the Cochrane Library were searched for studies from initiation up to April 2022. Studies describing the EA and EP in association with peri-implantitis were considered eligible for this review and selected for inclusion in this review if implant groups with wide and narrow EA and different EP types were described.
RESULTS
Searches in PubMed and the Cochrane Library led to 1116 unique titles and the inclusion of three studies. These concerned 168-349 implants. Two studies presented the mean prevalence of peri-implantitis which was 16.7% and 24.8% at the implant level. Both studies showed a significant relationship between peri-implantitis in bone-level implant groups with an EA above 30° compared to implants with an EA below 30°. A third study presented marginal bone loss which tended to be smaller when the EA was around 20°-40°. In one of the three included studies, the prevalence of peri-implantitis was significantly higher if implants had a convex EP compared to a concave or straight EP. Another study showed a significantly higher prevalence of peri-implantitis in implants with a convex EP compared to other EP types, if combined with an EA above 30°.
CONCLUSIONS
Three eligible studies were found. Reported associations should therefore be considered with caution. Synthesis suggests an association between a larger EA (>30°) and a higher prevalence of peri-implantitis or marginal bone loss compared to a smaller EA (<30°). A convex EP may also be associated with a higher prevalence of peri-implantitis. However, causality remains a question.
Topics: Alveolar Bone Loss; Dental Implants; Humans; Peri-Implantitis
PubMed: 35713938
DOI: 10.1002/cre2.594