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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 -
Periodontology 2000 Feb 2022Both fixed and removable implant-supported prostheses are well-established methods for replacing missing teeth in partially or fully edentulous patients. Numerous... (Review)
Review
Both fixed and removable implant-supported prostheses are well-established methods for replacing missing teeth in partially or fully edentulous patients. Numerous systematic reviews have been performed in recent years to evaluate the survival and complication rates of implant-retained fixed dental prostheses and implant-retained overdentures, displaying high 5-year survival rates ranging from 97.1% for fixed dental prostheses to 95%-100% for implant-retained overdentures. However, the survival rates only represent the prostheses remaining in use for a defined follow-up time, and do not account for the potential prosthetic complications that may have arisen and influence the general success of the implant treatment. The most common technical complications of fixed implant-retained single crowns are crown fracture, fractures of ceramic implant abutments, and esthetic problems. The predominant technical complication at multiple-unit, implant-retained fixed dental prostheses is fracture/chipping of the veneering ceramic. Reported technical complications for implant-retained overdentures are overdenture fracture or chipping of the veneer materials, whereas mechanical complications include implant fracture, attachment failure, and attachment housing or insert complications. To reduce the risk of such failures, a comprehensive pretreatment diagnostic work-up is essential, including defining the prosthetic goal with the aid of a wax-up or set-up and the associated ideal, prosthetically oriented three-dimensional implant position. Furthermore, selection of the ideal type of prosthesis, including the respective implant components and materials, is important for clinical long-term treatment success.
Topics: Crowns; Dental Implantation; Dental Implants; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Humans
PubMed: 35103329
DOI: 10.1111/prd.12416 -
Journal of Clinical Periodontology Jun 2023The recently published Clinical Practice Guidelines (CPGs) for the treatment of stages I-IV periodontitis provided evidence-based recommendations for treating...
BACKGROUND
The recently published Clinical Practice Guidelines (CPGs) for the treatment of stages I-IV periodontitis provided evidence-based recommendations for treating periodontitis patients, defined according to the 2018 classification. Peri-implant diseases were also re-defined in the 2018 classification. It is well established that both peri-implant mucositis and peri-implantitis are highly prevalent. In addition, peri-implantitis is particularly challenging to manage and is accompanied by significant morbidity.
AIM
To develop an S3 level CPG for the prevention and treatment of peri-implant diseases, focusing on the implementation of interdisciplinary approaches required to prevent the development of peri-implant diseases or their recurrence, and to treat/rehabilitate patients with dental implants following the development of peri-implant diseases.
MATERIALS AND METHODS
This S3 level CPG was developed by the European Federation of Periodontology, following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, formulation of specific recommendations, and a structured consensus process involving leading experts and a broad base of stakeholders.
RESULTS
The S3 level CPG for the prevention and treatment of peri-implant diseases culminated in the recommendation for implementation of various different interventions before, during and after implant placement/loading. Prevention of peri-implant diseases should commence when dental implants are planned, surgically placed and prosthetically loaded. Once the implants are loaded and in function, a supportive peri-implant care programme should be structured, including periodical assessment of peri-implant tissue health. If peri-implant mucositis or peri-implantitis are detected, appropriate treatments for their management must be rendered.
CONCLUSION
The present S3 level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to maintain healthy peri-implant tissues, and to manage peri-implant diseases, according to the available evidence at the time of publication.
Topics: Humans; Peri-Implantitis; Dental Implants; Mucositis; Tooth; Periodontitis
PubMed: 37271498
DOI: 10.1111/jcpe.13823 -
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 -
Dental Materials Journal Mar 2020Since 1970s, a lot of effort has been devoted toward the development of dental implants. Dental implants are nowadays an indispensable part of clinical dentistry. The...
Since 1970s, a lot of effort has been devoted toward the development of dental implants. Dental implants are nowadays an indispensable part of clinical dentistry. The global dental implant market is expected to reach $13 billion in 2023. Although, the survival rate of dental implants has been reported above 90%, compromised bone conditions promote implant failure and endanger the current high success rates. The main concern is related to the aging population. Diabetes, osteoporosis, obesity and use of drugs are all medical conditions, which can hamper bone healing around dental implants. In view of this, research toward developing better methods of enhancing implant osseointegration have to be continued, especially in the presence of impaired bone condition. In this paper, the current changes and their future perspective are discussed.
Topics: Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Design; Osseointegration; Titanium
PubMed: 31969548
DOI: 10.4012/dmj.2019-140 -
Dental Materials Journal Jan 2020This review scientifically compares the properties of zirconia and titanium, but does not identify the best among them as an implant material. Surface treatment and... (Review)
Review
This review scientifically compares the properties of zirconia and titanium, but does not identify the best among them as an implant material. Surface treatment and modification to improve tissue bonding and inhibit bacterial adhesion are not considered in this review. The mechanical properties of titanium are superior to those of zirconia; some studies have shown that zirconia can be used as a dental implant, especially as an abutment. Extensive surface treatment research is ongoing to inhibit bacterial adhesion and improve osseointegration and soft tissue adhesion phenomena which make it difficult to evaluate properties of the materials themselves without surface treatment. Osseointegration of titanium is superior to that of zirconia itself without surface treatment; after surface treatment, both materials show comparable osseointegration. The surface morphology is more important for osseointegration than the surface composition. To inhibit bacterial adhesion, zirconia is superior to titanium, and hence, more suitable for abutments. Both materials show similar capability for soft tissue adhesion.
Topics: Dental Abutments; Dental Implants; Dental Materials; Osseointegration; Surface Properties; Titanium; Zirconium
PubMed: 31666488
DOI: 10.4012/dmj.2019-172 -
Clinical Implant Dentistry and Related... Aug 2023Peri-implant mucosal integration is becoming a critical aspect for long term implant health and can be triggered the selection of implant components. The aim of this... (Review)
Review
Peri-implant mucosal integration is becoming a critical aspect for long term implant health and can be triggered the selection of implant components. The aim of this review is therefore to investigate the evidence concerning implant connection and abutment characteristics (abutment materials, design, handling) as predisposing or precipitating factor for peri-implant mucositis and peri-implantitis. Although the evidence that these features can directly predispose/precipitate peri-implant diseases is limited, there are -few- studies showing a potential role of the implant connection, trans-mucosal configuration, and handling in the development of early bone loss and/or peri-implantitis. With bone level implants, conical internal connections (with inherent platform switching) might be preferred over internal flat-flat and external connections to decrease the risk of early bone loss and potentially the risk of peri-implant disease. Moreover, there is a trend suggesting moving the prosthetic interface coronally (to the juxta-mucosal level) as soon as possible to reduce the number of disconnections and to limit the risk of cements remnants. This can be achieved by choosing a tissue-level implant or to place a trans-mucosal abutment (one abutment-one time approach) to optimize the peri-implant soft tissue seal. In absence of evidence for the biocompatibility regarding several restorative materials, biocompatible materials such as titanium or zirconia should be preferred in the trans-mucosal portion. Finally, higher implants (≥2mm) with an emergence angle below 30° seem more favourable. It should however be noted that some of this information is solely based on indirect information (such as early bone loss) and more research is needed before making firm recommendations about abutment choice. [Correction added on 13 March 2023, after first online publication: 'longer implants (≥2mm)' was changed to 'higher implants (≥2mm)' in this version.].
Topics: Humans; Peri-Implantitis; Dental Implants; Dental Implant-Abutment Design; Precipitating Factors; Dental Abutments
PubMed: 36825512
DOI: 10.1111/cid.13185 -
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 -
Periodontology 2000 Feb 2022The management and prevention of soft tissue complications is of key importance in modern implant dentistry and influences biologic and esthetic outcomes. The assessment... (Review)
Review
The management and prevention of soft tissue complications is of key importance in modern implant dentistry and influences biologic and esthetic outcomes. The assessment of the soft tissue conditions from a quantitative and qualitative perspective should, therefore, be part of the overall treatment plan. Such an assessment dictates a potential indication as well as an ideal time point for additional soft tissue management. A proper risk assessment and management of the soft tissues at the planned implant site are of key importance prior to any implant-related surgery. Cases with peri-implant soft tissue complications generally involve: (a) a lack of attached and keratinized mucosa; (b) insufficient volume; (c) development of mucosal dehiscences; or (d) a combination of (a), (b), and (c). In case of soft tissue deficiencies, these should be addressed as early as possible to increase the predictability of the surgical interventions. This article reviews the main causes for peri-implant soft tissue complications and presents different therapeutic options for the management of various clinical scenarios.
Topics: Dental Implants; Gingiva; Humans
PubMed: 35103320
DOI: 10.1111/prd.12415