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The International Journal of Oral &... 2023To evaluate the performance of one- and two-piece ceramic implants regarding implant survival and success and patient satisfaction. This review followed the PRISMA... (Meta-Analysis)
Meta-Analysis
To evaluate the performance of one- and two-piece ceramic implants regarding implant survival and success and patient satisfaction. This review followed the PRISMA 2020 guidelines using PICO format and analyzed clinical studies of partially or completely edentulous patients. The electronic search was conducted in PubMed/MEDLINE using Medical Subject Headings (MeSH) keywords related to dental zirconia ceramic implants, and 1,029 records were received for detailed screening. The data obtained from the literature were analyzed by single-arm, weighted meta-analyses using a random-effects model. Forest plots were used to synthesize pooled means and 95% CI for the change in marginal bone level (MBL) for short-term (1 year), mid-term (2 to 5 years), and long-term (over 5 years) follow-up time intervals. Among the 155 included studies, the case reports, review articles, and preclinical studies were analyzed for background information. A meta-analysis was performed for 11 studies for one-piece implants. The results indicated that the MBL change after 1 year was 0.94 ± 0.11 mm, with a lower bound of 0.72 and an upper bound of 1.16. For the mid term, the MBL was 1.2 ± 0.14 mm with a lower bound of 0.92 and an upper bound of 1.48. For the long term, the MBL change was 1.24 ± 0.16 mm with a lower bound of 0.92 and an upper bound of 1.56. Based on this literature review, one-piece ceramic implants achieve osseointegration similar to titanium implants, with a stable MBL or a slight bone gain after an individual initial design depending on crestal remodeling. The risk of implant fracture is low for current commercially available implants. Immediate loading or temporization of the implants does not interfere with the course of osseointegration. Scientific evidence for two-piece implants is rare.
Topics: Humans; Dental Implants; Ceramics; Dental Restoration, Temporary; Mouth, Edentulous; Osseointegration
PubMed: 37436947
DOI: 10.11607/jomi.10500 -
Journal of Prosthodontics : Official... Oct 2022The purpose of this systematic review and meta-analysis was to evaluate the effect of using additive manufacturing (AM) for dental ceramic fabrication in comparison with... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The purpose of this systematic review and meta-analysis was to evaluate the effect of using additive manufacturing (AM) for dental ceramic fabrication in comparison with subtractive manufacturing (SM), and to evaluate the effect of the type of AM technology on dental ceramic fabrication.
MATERIALS AND METHODS
A search was conducted electronically in MEDLINE (via PubMed), EBSCOhost, Scopus, and Cochran Library databases, and also by other methods (table of contents screening, backward and forward citations, and grey literature search) up to February 12, 2022, to identify records evaluating additive manufacturing of ceramics for dental purposes in comparison with subtractive manufacturing. A minimum of 2 review authors conducted tstudy selection, quality assessment, and data extraction. Quality assessment was performed with Joanna Briggs Institute tool, and the quantitative synthesis was performed with the Comprehensive Meta-Analysis program (CMA, Biostat Inc). Hedges's g for effect size was calculated, with 0.2 as small, 0.5 as medium, and 0.8 as large. Heterogeneity was assessed with I and prediction interval (PI) statistics. Publication bias was investigated with funnel plots and grey literature search. Certainty of evidence was assessed with the Grading of Recommendations: Assessment, Development, and Evaluation (GRADE) tool.
RESULTS
A total of 28 studies were included for the qualitative and quantitative synthesis; 11 in vitro studies on accuracy, 1 in vivo study on color, and 16 in vitro studies on physical and mechanical properties. Meta-analysis showed overall higher accuracy for SM compared with AM, with medium effect size (0.679, CI: 0.173 to 1.185, p = 0.009) and also for marginal (g = 1.05, CI: 0.344 to 1.760, p = 0.004), occlusal (g = 2.24, CI: 0.718 to 3.766, p = 0.004), and total (g = 4.544, CI: -0.234 to 9.323, p = 0.062) with large effect size; whereas AM had higher accuracy than SM with small effect size for the external (g = -0.238, CI: -1.215 to 0.739), p = 0.633), and internal (g = -0.403, CI: -1.273 to 0.467, p = 0.364) surfaces. For technology, self-glazed zirconia protocol had the smallest effect size (g = -0.049, CI: -0.878 to 0.78, p = 0.907), followed by stereolithography (g = 0.305, CI: -0.289 to 0.9, p = 0.314), and digital light processing (g = 1.819, CI: 0.662 to 2.976, p = 0.002) technologies. Flexural strength was higher for ceramics made by SM in comparison to AM with large effect size (g = -2.868, CI: -4.371 to -1.365, p < 0.001). Only 1 study reported on color, favoring ceramics made through combined AM and SM.
CONCLUSIONS
Subtractive manufacturing had better overall accuracy, particularly for the marginal and occlusal areas, higher flexural strength, and more favorable hardness, fracture toughness, porosity, fatigue, and volumetric shrinkage; whereas AM had more favorable elastic modulus and wettability. Both methods had favorable biocompatibility. All studies on accuracy and mechanical properties were in vitro, with high heterogeneity and low to very low certainty of evidence. There is a lack of studies on color match and esthetics.
Topics: Computer-Aided Design; Esthetics, Dental; Zirconium; Ceramics; Flexural Strength; Stereolithography; Materials Testing; Dental Porcelain; Surface Properties
PubMed: 35675133
DOI: 10.1111/jopr.13553 -
Clinical Oral Implants Research Sep 2023To compare and report on the performance of implant-supported fixed dental prostheses (iFDPs) fabricated using additive (AM) or subtractive (SM) manufacturing. (Review)
Review
AIM
To compare and report on the performance of implant-supported fixed dental prostheses (iFDPs) fabricated using additive (AM) or subtractive (SM) manufacturing.
METHODS
An electronic search was conducted (Medline, Embase, Cochrane Central, Epistemonikos, clinical trials registries) with a focused PICO question: In partially edentulous patients with missing single (or multiple) teeth undergoing dental implant therapy (P), do AM iFDPs (I) compared to SM iFDPs (C) result in improved clinical performance (O)? Included were studies comparing AM to SM iFDPs (randomized clinical trials, prospective/retrospective clinical studies, case series, in vitro studies).
RESULTS
Of 2'184 citations, no clinical study met the inclusion criteria, whereas six in vitro studies proved to be eligible. Due to the lack of clinical studies and considerable heterogeneity across the studies, no meta-analysis could be performed. AM iFDPs were made of zirconia and polymers. For SM iFDPs, zirconia, lithium disilicate, resin-modified ceramics and different types of polymer-based materials were used. Performance was evaluated by assessing marginal and internal discrepancies and mechanical properties (fracture loads, bending moments). Three of the included studies examined the marginal and internal discrepancies of interim or definitive iFDPs, while four examined mechanical properties. Based on marginal and internal discrepancies as well as the mechanical properties of AM and SM iFDPs, the studies revealed inconclusive results.
CONCLUSION
Despite the development of AM and the comprehensive search, there is very limited data available on the performance of AM iFDPs and their comparison to SM techniques. Therefore, the clinical performance of iFDPs by AM remains to be elucidated.
Topics: Humans; Prospective Studies; Retrospective Studies; Dental Implants; Ceramics; Polymers
PubMed: 37750533
DOI: 10.1111/clr.14085 -
Clinical Oral Investigations Nov 2023This systematic review assessed the available evidence on the survival and success rate of zirconia and titanium implants. As secondary outcomes, aesthetic, radiographic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review assessed the available evidence on the survival and success rate of zirconia and titanium implants. As secondary outcomes, aesthetic, radiographic and clinical parameters, as well as biological and mechanical complications, were considered.
MATERIALS AND METHODS
A systematic search was performed up to March 2022 to identify CCTs/RCTs comparing zirconia and titanium implants with a minimum of 12 months of follow-up. Meta-analysis was performed when ≥ 2 articles with similar characteristics were retrieved.
RESULTS
Four published articles with two RCTs (2 different patient populations) with 100 zirconia and 99 titanium implants that were followed up over 12-80 months were selected out of the 6040 articles. A non-statistically significant difference between zirconia and titanium implant survival at 12 months was suggested (P = 0.0938). The success rates were 57.5-93.3% and 57.1-100% for zirconia and titanium implants, respectively. The pink aesthetic score (PES) was higher for zirconia (10.33 ± 2.06 to 11.38 ± 0.92) compared to titanium implants (8.14 ± 3.58 to 11.56 ± 1.0).
CONCLUSION
Based on the 2 RCTs retrieved in the literature, similar survival rates were reported for zirconia and titanium implants in the short term (12 months of follow-up). Future RCTs are warranted to evaluate the long-term outcomes of zirconia implants.
CLINICAL RELEVANCE
Zirconia implants may be the procedure of choice, particularly in the aesthetic zone, since they show a similar survival and success rate as titanium implants on a short-term follow-up.
TRIAL REGISTRATION
Systematic review registration number-CRD42021288704 (PROSPERO).
Topics: Humans; Dental Implants; Titanium; Dental Restoration Failure; Esthetics, Dental; Zirconium; Dental Prosthesis Design
PubMed: 37740825
DOI: 10.1007/s00784-023-05242-5 -
Dental Materials : Official Publication... Dec 2023Titanium particles have been shown in in-vitro studies to lead to the activation of specific pathways, this work aims to systematically review in- vivo studies examining... (Review)
Review
OBJECTIVE
Titanium particles have been shown in in-vitro studies to lead to the activation of specific pathways, this work aims to systematically review in- vivo studies examining peri-implant and periodontal tissues at the transcriptome, proteome, epigenome and genome level to reveal implant material-related processes favoring peri-implantitis development investigated in animal and human trials.
METHODS
Inquiring three literature databases (Medline, Embase, Cochrane) a systematic search based on a priori defined PICOs was conducted: '-omics' studies comparing molecular signatures in healthy and infected peri-implant sites and/or healthy and periodontitis-affected teeth in animals/humans. After risk of bias assessments, lists of differentially expressed genes and results of functional enrichment analyses were compiled whenever possible.
RESULTS
Out of 2187 screened articles 9 publications were deemed eligible. Both healthy and inflamed peri-implant tissues showed distinct gene expression patterns compared to healthy/diseased periodontal tissues in animal (n = 4) or human studies (n = 5), with immune response, bone metabolism and oxidative stress being affected the most. Due to the lack of available re-analyzable data and inconsistency in methodology of the eligible studies, integrative analyses on differential gene expression were not applicable CONCLUSION: The differences of transcriptomic signatures in between peri-implant lesions compared to periodontal tissue might be related to titanium particles arising from dental implants and are in line with the in-vitro data recently published by our group. Nevertheless, limitations emerge from small sample sizes of included studies and insufficient publication of re-analyzable data.
Topics: Humans; Peri-Implantitis; Dental Implants; Titanium; Periodontitis; Tooth
PubMed: 37839998
DOI: 10.1016/j.dental.2023.09.007 -
The Journal of Evidence-based Dental... Dec 2023The aim of this systematic review was to evaluate the survival and complication rates of resin composite laminate veneers. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The aim of this systematic review was to evaluate the survival and complication rates of resin composite laminate veneers.
METHODS
Randomized controlled trials and cohort studies with a minimum 2-year follow-up assessing survival and complication rates of resin composite laminate veneers on permanent dentition from 1998 to May 2022. Literature searches were conducted in MEDLINE (PubMed), Scopus, and the Cochrane Central Register of Controlled Trials electronic databases. References cited in the related reviews and included full-text articles were also hand-searched to further identify potentially relevant studies.
RESULTS
A total of 827 articles were identified. Twenty-two studies were considered for full-text review after the title and abstract screening stage. After exclusion, 7 studies (3 randomized controlled trials and 4 cohort studies) were included in the systematic review. Three published scales were adopted for the quality and risk of bias assessment. At the survival rate threshold, the overall heterogeneity (I) for randomized controlled trials was 50.5% (P = .108). The overall pooled survival rate of the randomized controlled trials was 88% (95% CI: 81%-94%), with the mean follow-up time ranging from 24 to 97 months. Surface roughness, color mismatch, and marginal discoloration were the most reported complications.
CONCLUSION
Resin composite laminate veneers demonstrated moderately high survival rates for the entire sample and the direct laminate veneer group demonstrated higher survival rates than the indirect approach. Most of the complications were regarded as clinically acceptable with or without reintervention.
Topics: Humans; Dental Porcelain; Composite Resins; Dental Restoration Failure
PubMed: 38035903
DOI: 10.1016/j.jebdp.2023.101911 -
Clinical Oral Implants Research Sep 2023The objectives of the study were to assess the survival, failure, and technical complication rates of implant-supported fixed dental prosthesis (iFDPs) with pontic or... (Meta-Analysis)
Meta-Analysis Review
Systematic review evaluating the influence of the prosthetic material and prosthetic design on the clinical outcomes of implant-supported multi-unit fixed dental prosthesis in the posterior area.
OBJECTIVE
The objectives of the study were to assess the survival, failure, and technical complication rates of implant-supported fixed dental prosthesis (iFDPs) with pontic or splinted crown (iS C) designs in the posterior area and compare the influence of prosthetic materials and prosthetic design on the outcomes.
METHODS
Electronic and manual searches were performed to identify randomized-, prospective-, and retrospective clinical trials with follow-up time of ≥12 months, evaluating the clinical outcomes of posterior iFDPs with pontic or iS Cs. Survival and complication rates were analyzed using robust Poisson's regression models.
RESULTS
Thirty-two studies reporting on 42 study arms were included in the present systematic review. The meta-analysis of the included studies indicated estimated 3-year survival rates of 98.3% (95%CI: 95.6-99.3%) for porcelain-fused-to-metal (PFM) iFDPs, 97.5% (95%CI: 95.5-98.7%) for veneered zirconia (Zr) iFDPs with pontic, 98.9% (95%CI: 96.8-99.6%) for monolithic or micro-veneered zirconia iFDPs with pontic, and 97.0% (95%CI: 84.8-99.9%) for lithium disilicate iFDPs with pontics. The survival rates for different material combination showed no statistically significant differences. Veneered restorations, overall, showed significantly (p < .01) higher ceramic fracture and chipping rates compared with monolithic restorations. Furthermore, there was no significant difference in survival rates (98.3% [95%CI: 95.6-99.3%] vs. 99.1% [95%CI: 97.6-99.7%]) and overall complication rates between PFM iFDPs with pontic and PFM iS Cs.
CONCLUSIONS
Based on the data identified by this systematic review, PFM, veneered Zr, and monolithic Zr iFDPs with pontic and iS Cs showed similarly high short-term survival rates in the posterior area. Veneered restorations exhibit ceramic chipping more often than monolithic restorations, with the highest fracture rate reported for veneered Zr iFDPs.
Topics: Prospective Studies; Retrospective Studies; Dental Prosthesis Design; Dental Restoration Failure; Dental Porcelain; Ceramics; Zirconium; Crowns; Dental Prosthesis, Implant-Supported
PubMed: 37750526
DOI: 10.1111/clr.14103 -
PloS One 2022The objective of this report was to provide a review of the minipig intraoral dental implant model including a meta-analysis to estimate osseointegration and crestal... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The objective of this report was to provide a review of the minipig intraoral dental implant model including a meta-analysis to estimate osseointegration and crestal bone remodeling.
METHODS
A systematic review including PubMed and EMBASE databases through June 2021 was conducted. Two independent examiners screened titles/abstracts and selected full-text articles. Studies evaluating titanium dental implant osseointegration in native alveolar bone were included. A quality assessment of reporting was performed. Random-effects meta-analyses and meta-regressions were produced for bone-implant contact (BIC), first BIC, and crestal bone level.
RESULTS
125 out of 249 full-text articles were reviewed, 55 original studies were included. Quality of reporting was generally low, omissions included animal characteristics, examiner masking/calibration, and sample size calculation. The typical minipig model protocol included surgical extraction of the mandibular premolars and first molar, 12±4 wks post-extraction healing, placement of three narrow regular length dental implants per jaw quadrant, submerged implant healing and 8 wks of osseointegration. Approximately 90% of studies reported undecalcified incandescent light microscopy histometrics. Overall, mean BIC was 59.88% (95%CI: 57.43-62.33). BIC increased significantly over time (p<0.001): 40.93 (95%CI: 34.95-46.90) at 2 wks, 58.37% (95%CI: 54.38-62.36) at 4 wks, and 66.33% (95%CI: 63.45-69.21) beyond 4 wks. Variability among studies was mainly explained by differences in observation interval post-extraction and post-implant placement, and implant surface. Heterogeneity was high for all studies (I2 > 90%, p<0.001).
CONCLUSIONS
The minipig intraoral dental implant model appears to effectively demonstrate osseointegration and alveolar bone remodeling similar to that observed in humans and canine models.
Topics: Dental Implants
PubMed: 35226690
DOI: 10.1371/journal.pone.0264475 -
Acta Stomatologica Croatica Mar 2021Ion-incorporated zeolite is a widely used antimicrobial material studied for various dental applications. At present, there is no other systematic review that evaluates... (Review)
Review
OBJECTIVE
Ion-incorporated zeolite is a widely used antimicrobial material studied for various dental applications. At present, there is no other systematic review that evaluates the effectiveness of zeolite in all dental materials. The purpose of this study was to review all available literature that analyzed the antimicrobial effects and/or mechanical properties of zeolite as a restorative material in dentistry.
MATERIAL AND METHODS
Following PRISMA guidelines, an exhaustive search of PubMed, Ovid Medline, Scopus, Embase, and the Dentistry & Oral Sciences Source was conducted. No language or time restrictions were used and the study was conducted from June 1, 2020 to August 17, 2020. Only full text articles were selected that pertained to the usage of zeolite in dental materials including composite resin, bonding agents, cements, restorative root material, cavity base material, prosthesis, implants, and endodontics.
RESULTS
At the beginning of the study, 1534 studies were identified, of which 687 duplicate records were excluded. After screening for the title, abstract, and full texts, 35 articles remained and were included in the qualitative synthesis. An Inter-Rater Reliability (IRR) test, which included a percent user agreement and reliability percent, was conducted for each of the 35 articles chosen.
CONCLUSION
Although ion-incorporated zeolite may enhance the antimicrobial properties of dental materials, the mechanical properties of some materials, such as MTA and acrylic resin, may be compromised. Therefore, since the decrease in mechanical properties depends on zeolite concentration in the restorative material, it is generally recommended to add 0.2-2% zeolite by weight.
PubMed: 33867540
DOI: 10.15644/asc55/1/9 -
The Journal of Prosthetic Dentistry Mar 2022How the performance of dental implants is related to their occlusogingival placement, crestal or subcrestal, is unclear. (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
How the performance of dental implants is related to their occlusogingival placement, crestal or subcrestal, is unclear.
PURPOSE
The purpose of this systematic review and meta-analysis was to evaluate marginal bone loss, implant survival rate, and peri-implant soft tissue parameters between implants placed at the crestal and subcrestal bone level.
MATERIAL AND METHODS
Two independent reviewers searched the PubMed/MEDLINE, Embase, and Cochrane Library databases for randomized clinical trials published up to September 2020. The meta-analysis was based on the Mantel-Haenszel and the inverse variance methods (α=.05).
RESULTS
The search identified 928 references, and 10 studies met the eligibility criteria. A total of 393 participants received 709 implants, 351 at crestal bone levels and 358 at subcrestal bone levels. Meta-analysis indicated that crestal bone level implants showed similar marginal bone loss to that seen with subcrestal bone level implants (mm) (P=.79), independent of the subcrestal level (P=.05) and healing protocol (P=.24). The bone level implant placement did not affect the implant survival rate (P=.76), keratinized tissue (mm) (P=.91), probing depth (mm) (P=.70), or plaque index (%) (P=.92).
CONCLUSIONS
The evidence suggests that both approaches of implant placement are clinically acceptable in terms of peri-implant tissue parameters and implant-supported restoration survival.
Topics: Alveolar Bone Loss; Dental Implantation, Endosseous; Dental Implants; Humans; Wound Healing
PubMed: 33358610
DOI: 10.1016/j.prosdent.2020.11.003