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The British Journal of Oral &... Dec 2022Computerised surgical planning (CSP) and computer-aided design and manufacturing (CAD/CAM) have been demonstrated to increase surgical accuracy and reduce operative time... (Meta-Analysis)
Meta-Analysis Review
Computerised surgical planning (CSP) and computer-aided design and manufacturing (CAD/CAM) have been demonstrated to increase surgical accuracy and reduce operative time in free flap mandibular reconstruction, but evidence is lacking as to their impact on patient-centred outcomes. Implant-supported dental prostheses, however, have been associated with improved quality of life outcomes following free flap mandibular reconstruction. We aim to review reported patient-centred outcomes in mandibular reconstruction with CSP and CAD/CAM and determine whether use of these technologies is associated with higher rates of dental implant placement following free flap mandibular reconstruction. On December 20, 2020, a systematic review and meta-analysis were conducted according to PRISMA guidelines for studies reporting quality of life, functional outcomes, and rates of dental implant placement in computer-aided free flap mandibular reconstruction. A random-effects meta-analysis was performed to compare dental implant placement rates between surgeries using CSP and those using conventional freehand techniques. A total of 767 articles were screened. Nine articles reporting patient-centred outcomes and 16 articles reporting dental implant outcomes were reviewed. Of those reporting dental implant outcomes, five articles, representing a total of 302 cases, were included in the meta-analysis. Use of CSP was associated with a significant increase in the likelihood of dental implant placement, with an odds ratio of 2.70 (95% CI 1.52 to 4.79, p = 0.0007). Standardised reporting methods and controlled studies are needed to further investigate the impact of CSP and CAD/CAM technologies on functional outcomes and patient-reported quality of life in free flap mandibular reconstruction. Use of CSP and CAD/CAM technologies is associated with higher rates of dental implant placement in patients undergoing free flap mandibular reconstruction when compared to conventional freehand techniques.
Topics: Humans; Dental Implants; Mandibular Reconstruction; Free Tissue Flaps; Quality of Life; Fibula; Computer-Aided Design
PubMed: 36280538
DOI: 10.1016/j.bjoms.2022.09.006 -
Clinical Oral Implants Research Feb 2016A systematic review and meta-analysis are carried out to assess the scientific evidence that bisphosphonate therapy can decrease the success rate of dental implants. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
A systematic review and meta-analysis are carried out to assess the scientific evidence that bisphosphonate therapy can decrease the success rate of dental implants.
MATERIAL AND METHODS
The PubMed (Medline) database was used to search for articles published up until February 22, 2014. The meta-analysis was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The Newcastle-Ottawa scale (NOS) was used to assess study quality.
RESULTS
The combinations of search terms resulted in a list of 256 titles. Fourteen finally met the inclusion criteria and were thus selected for inclusion in the systematic review. Eight studies (six retrospective and two prospective) were included in the meta-analysis, with a total of 1288 patients (386 cases and 902 controls) and 4562 dental implants (1090 dental implants in cases and 3472 in controls). The summary odds ratio (OR = 1.43, P = 0.156) indicates that there is not enough evidence that bisphosphonates have a negative impact upon implant survival. According to the number need to harm (NNH), over 500 dental implants are required in patients receiving bisphosphonate treatment to produce a single implant failure.
CONCLUSION
Our results show that dental implant placement in patients receiving bisphosphonates does not reduce the dental implant success rate. On the other hand, such patients are not without complications, and risk evaluation therefore must be established on an individualized basis, as one of the most serious though infrequent complications of bisphosphonate therapy is bisphosphonate-related osteonecrosis of the jaws. Given the few studies included in our meta-analysis, further prospective studies involving larger sample sizes and longer durations of follow-up are required to confirm the results obtained.
Topics: Bone Density Conservation Agents; Dental Implantation, Endosseous; Dental Implants; Dental Restoration Failure; Diphosphonates; Humans
PubMed: 25406770
DOI: 10.1111/clr.12526 -
Journal of Dentistry May 2015Recent studies implicate smoking as a significant factor in the failure of dental implants. This review aims to test the null hypothesis of no difference in the implant... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Recent studies implicate smoking as a significant factor in the failure of dental implants. This review aims to test the null hypothesis of no difference in the implant failure rates, risk of postoperative infection, and marginal bone loss for smokers versus non-smokers, against the alternative hypothesis of a difference.
DATA
Main search terms used in combination: dental implant, oral implant, smoking, tobacco, nicotine, smoker, and non-smoker.
SOURCES
An electronic search was undertaken in September/2014 in PubMed/Medline, Web of Science, Cochrane Oral Health Group Trials Register plus hand-searching.
STUDY SELECTION
Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 1432 publications, of which 107 were eligible, with 19,836 implants placed in smokers, with 1259 failures (6.35%), and 60,464 implants placed in non-smokers, with 1923 failures (3.18%).
CONCLUSIONS
The insertion of implants in smokers significantly affected the failure rates, the risk of postoperative infections as well as the marginal bone loss. The results should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies.
CLINICAL SIGNIFICANCE
Smoking is a factor that has the potential to negatively affect healing and the outcome of implant treatment. It is important to perform an updated periodic review to synthesize the clinical research evidence relevant to the matter.
Topics: Alveolar Bone Loss; Dental Implants; Dental Restoration Failure; Humans; Periodontal Diseases; Smoking
PubMed: 25778741
DOI: 10.1016/j.jdent.2015.03.003 -
International Journal of Oral and... Mar 2022During the last decades, the number of immunosuppressed organ transplant patients has increased consistently. Nevertheless, immunosuppression has been discussed as a... (Review)
Review
During the last decades, the number of immunosuppressed organ transplant patients has increased consistently. Nevertheless, immunosuppression has been discussed as a contraindication for dental implant procedures for many years. Hence, the purpose of this systematic review was to assess the survival rate and outcomes of dental implants after solid organ transplantation. An electronic and manual literature search was conducted up to March 2021. Publications describing dental implants placed in patients after organ transplantation were included without any limitations regarding study design or date of publication. Ten articles met the inclusion criteria, leading to a sample of 93 patients with 249 implants. Implant survival rates were 100% over a mean follow-up of 60 months. In every case, implant surgery was performed under antibiotic coverage. No major medication-related complications were reported. Despite the limited amount of evidence in the literature, implant procedures seem to be a safe treatment option in immunosuppressed organ transplant patients. The observance of appropriate treatment protocols including a strict maintenance programme seems to be crucial for the long-term success of such treatments. However, stringent data regarding various influencing factors such as the prevalence of peri-implantitis are still missing.
Topics: Dental Implants; Dental Restoration Failure; Humans; Immunocompromised Host; Organ Transplantation; Peri-Implantitis
PubMed: 34274207
DOI: 10.1016/j.ijom.2021.06.008 -
Journal of Clinical Periodontology Jun 2023To assess the impact of mucoperiosteal flap elevation for single immediate implant placement (IIP) on buccal hard and soft tissue changes, and on clinical, aesthetic and... (Meta-Analysis)
Meta-Analysis Review
AIM
To assess the impact of mucoperiosteal flap elevation for single immediate implant placement (IIP) on buccal hard and soft tissue changes, and on clinical, aesthetic and patient-reported outcomes.
MATERIALS AND METHODS
Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase and Cochrane databases as well as a manual search to identify eligible clinical studies up to June 2022. Randomized controlled trials (RCTs) comparing IIP without flap elevation to IIP with flap elevation were included for a qualitative and quantitative analysis. The primary outcome was horizontal buccal bone change. Secondary outcomes were implant survival, vertical buccal bone change, pain, and clinical and aesthetic parameters.
RESULTS
Out of 1029 records, 5 RCTs were selected reporting on 140 patients who received 140 single immediate implants (flapless: 68; flap: 72). Patients had a mean age ranging from 30 to 67 years and were followed between 6 and 12 months. Four RCTs pertained to (nearly) intact alveoli. Risk of bias assessment yielded low risk for two RCTs and high risk for three RCTs. Meta-analysis demonstrated a mean difference of 0.48 mm (95% confidence interval [CI] [0.13, 0.84], p = .007) in horizontal buccal bone change between surgical approaches, favouring flapless surgery. Meta-analysis failed to demonstrate a significant difference in implant survival between the groups (RR 1.00, 95% CI [0.93, 1.07], p = .920). Given the scarcity of data, meta-analyses could not be performed on other secondary outcomes. Available studies were consistent in the direction of the effect favouring flapless surgery for vertical buccal bone change as well as for pain. Clinical and aesthetic parameters were underreported.
CONCLUSIONS
Based on CBCT data, flapless surgery resulted in more buccal bone preservation at immediate implants. However, the clinical relevance of this finding is unclear, since clinical and aesthetic outcomes were underreported.
Topics: Humans; Child, Preschool; Dental Implantation, Endosseous; Dental Implants; Esthetics, Dental; Surgical Flaps; Bias; Immediate Dental Implant Loading
PubMed: 36843361
DOI: 10.1111/jcpe.13795 -
Medicina Oral, Patologia Oral Y Cirugia... Sep 2021To assess the effectiveness of preemptive analgesia in dental implant surgery in randomized controlled trials (RCTs). (Meta-Analysis)
Meta-Analysis
BACKGROUND
To assess the effectiveness of preemptive analgesia in dental implant surgery in randomized controlled trials (RCTs).
MATERIAL AND METHODS
The present study was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered in PROSPERO database CRD42020168757. A search without restrictions regarding language or date of publication was conducted in six databases and gray literature. A random effect meta-analysis compared the efficacy of preemptive analgesia compared to placebo through pooled OR and 95%CI. The interpretation of results followed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach together with the magnitude of the effect according to GRADE guidelines.
RESULTS
Four studies were included in the review and three were incorporated into the meta-analysis. All studies demonstrated that preemptive analgesia contributed to a significant improvement in the postoperative pain control. However, the overall pooled standard mean difference (SMD) showed that preemptive analgesia had small effects compared to placebo in reducing pain (SMD: -0.45; IC: -0.83; -0.08) with low certainty of the evidence. Our meta-analysis showed that the magnitude of the effect was bigger six to eight hours after the surgery (large effect), compared to the time of one to two hours after the surgery (small effect).
CONCLUSIONS
Preemptive analgesia may have a positive effect in reducing pain compared to not using preemptive medication, but the evidence is very uncertain.
Topics: Analgesia; Dental Implants; Humans; Randomized Controlled Trials as Topic
PubMed: 34415001
DOI: 10.4317/medoral.24639 -
The Journal of Prosthetic Dentistry Sep 2023Immediate implant placement provides a popular therapeutic option. However, compromised sockets may jeopardize the treatment outcome. (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
Immediate implant placement provides a popular therapeutic option. However, compromised sockets may jeopardize the treatment outcome.
PURPOSE
The purpose of this systematic review and meta-analysis was to investigate the treatment outcome in terms of the implant survival rate and success parameters of immediate implant placement in compromised extraction sockets.
MATERIAL AND METHODS
An electronic search was conducted in PubMed, Embase, Cochrane Library, and ISI Web of Science up to January 2021. Studies evaluating implant survival rate and main success parameters were included for a qualitative and quantitative analysis (risk ratio and mean difference).
RESULTS
In total, 43 studies with analysis of 4825 sockets were included. Compared with the noncompromised sockets, the compromised group showed no significant differences in implant survival rates (risk ratio=0.992; 95% confidence interval (CI)=0.979 to 1.005; P=.246). No significant statistical differences were found in marginal bone level at ≤12 months (mean difference [MD]=0.033; 95% CI=-0.012 to 0.078; P=.154) or esthetic parameters.
CONCLUSIONS
Immediate implant placement in compromised sites does not appear to decrease the survival and success rates. However, randomized clinical trials with large sample sizes should be conducted to draw a definite conclusion about the efficacy and safety of this treatment protocol in compromised sockets.
Topics: Dental Implantation, Endosseous; Dental Implants; Tooth Socket; Esthetics, Dental; Immediate Dental Implant Loading
PubMed: 34772483
DOI: 10.1016/j.prosdent.2021.09.025 -
Clinical Implant Dentistry and Related... Aug 2021To assess the efficacy of using a bone substitute material (BSM) in the fixture-socket gap in patients undergoing tooth extraction and immediate implant placement. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the efficacy of using a bone substitute material (BSM) in the fixture-socket gap in patients undergoing tooth extraction and immediate implant placement.
MATERIALS AND METHODS
MEDLINE, EMBASE, and CENTRAL databases were searched for randomized controlled trials (RCTs). RCTs were screened for eligibility, and data were extracted by two authors independently. Risk of bias (ROB) was assessed using Cochrane's ROB tool 2.0. Primary outcomes were implant failure, overall complications, and soft-tissue esthetics. Secondary outcomes were vertical buccal bone resorption, vertical interproximal bone resorption, horizontal buccal bone resorption, and mid-buccal mucosal recession. Meta-analysis was performed using random-effects model with generic inverse variance weighing. GRADE was used to grade the certainty of the evidence.
RESULTS
After screening 19 544 potentially eligible references, 20 RCTs were included in this review, with a total of 848 patients (916 sites). Most included RCTs were deemed of some concerns (53%) or at low (38%) risk of bias, except for overall complications (high ROB). Implant failure did not differ significantly RR = 0.92 (confidence intervals [CI] 0.34 to 2.46) between using a BSM compared with not using a BSM (NoBSM). BSM use resulted in less horizontal buccal bone resorption (MD = -0.52 mm [95% CI -0.74 to -0.30]), a higher esthetic score (MD = 1.49 [95% CI 0.46 to 2.53]), but also more complications (RR = 3.50 [95% CI 1.11 to 11.1] compared with NoBSM. Too few trials compared types of BSMs against each other to allow for pooled analyses. The certainty of the evidence was considered moderate for all outcomes except implant failure (low), overall complications (very low), and vertical interproximal bone resorption (very low).
CONCLUSION
BSM use during immediate implant placement reduces horizontal buccal bone resorption and improves the periimplant soft-tissue esthetics. Although BSM use increases the risk of predominantly minor complications.
Topics: Bone Substitutes; Dental Implantation, Endosseous; Dental Implants; Esthetics, Dental; Humans; Tooth Extraction
PubMed: 34118175
DOI: 10.1111/cid.13014 -
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 -
Clinical Oral Implants Research Aug 2017This systematic review was conducted to evaluate the outcome of dental implant therapy in elderly patients (≥65 years). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review was conducted to evaluate the outcome of dental implant therapy in elderly patients (≥65 years).
MATERIAL AND METHODS
Online database and hand searches were systematically performed to identify studies reporting on dental implants placed in the partially/completely edentulous jaws of elderly patients. Only prospective studies reporting on regular-diameter (≥3 mm), micro-rough surface implants were included in this review. Two investigators performed the search and data extraction. An inter-investigator reliability was verified using kappa statistics (κ). A meta-analysis was performed on implant survival rates, while the mean peri-implant marginal bone level changes (PI-MBL), technical/mechanical complications, and biological complications were reported descriptively.
RESULTS
The systematic search yielded 2221 publications, of which 11 studies were included for statistical analyses. The calculated κ for the various parameters extracted was κ = 0.818-1.000. A meta-analysis was performed on the post-loading implant survival rates at 1, 3, 5, and 10 years. The random-effects model revealed an overall 1-year implant survival of 97.7% (95% CI: 95.8, 98.8; I = 0.00%, P = 0.968; n = 11 studies). The model further revealed an overall implant survival of 96.3% (95% CI: 92.8, 98.1; I = 0.00%, P = 0.618; n = 6 studies), 96.2% (95% CI: 93.0, 97.9; I = 0.00%, P = 0.850; n = 7 studies), and 91.2% (95% CI: 83.4, 95.6; I = 0.00%, P = 0.381; n = 3 studies) for 3, 5, and 10 years, respectively. The reported 1-year average PI-MBL ranged between 0.1 and 0.3 mm, while the reported 5- and 10-year PI-MBL were 0.7 and 1.5 mm, respectively. Information obtained pertaining to the technical and biological complications in the included studies was inadequate for statistical analysis. The frequent technical/mechanical complications reported were abutment screw loosening, fracture of the overdenture prostheses, activation of retentive clips, ceramic chipping, and fractures. The common biological complication reported included peri-implant mucositis, mucosal enlargement, bone loss, pain, and implant loss.
CONCLUSIONS
This review provides robust evidence favoring dental implant therapy in elderly patients as a predictable long-term treatment option, in terms of implant survival, clinically acceptable PI-MBL changes, and minimal complications. Therefore, age alone should not be a limiting factor for dental implant therapy.
Topics: Age Factors; Aged; Dental Implantation; Dental Implants; Dental Restoration Failure; Humans; Jaw, Edentulous; Treatment Outcome
PubMed: 27273468
DOI: 10.1111/clr.12898