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The International Journal of Oral &... 2016This systematic review aimed to compare immediate protocols with conventional protocols of single-tooth implants in terms of changes in the surrounding hard and soft... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This systematic review aimed to compare immediate protocols with conventional protocols of single-tooth implants in terms of changes in the surrounding hard and soft tissue in the esthetic area.
MATERIALS AND METHODS
Electronic and manual searches were performed in PubMed, EMBASE, Cochrane, and other data systems for research articles published between January 2001 and December 2014. Only randomized controlled trials (RCTs) reporting on hard and or soft tissue characteristics following a single-tooth implant were included. Based on the protocol used in each study, the included studies were categorized into three groups to assess the relationships between the factors and related esthetic indexes. Variables such as marginal bone level changes (mesial, distal, and mean bone level), peri-implant soft tissue changes (papilla level, midbuccal mucosa, and probing depth), and other esthetic indices were taken into consideration. The data were analyzed using RevMan version 5.3, Stata 12, and GRADEpro 3.6.1 software.
RESULTS
A total of 13 RCTs met the inclusion criteria. Four studies examined immediate implant placement, five studies examined immediate implant restoration, and four studies examined immediate loading. Comparing the bone level changes following immediate and conventional restoration, no significant differences were found in the bone level of the mesial site (standard mean difference [SMD] = -0.04 mm; 95% confidence interval [CI]: -0.25 to 0.17 mm), the distal site (SMD = -0.15 mm; 95% CI: -0.38 to 0.09 mm), and the mean bone level changes (SMD = 0.05 mm; 95% CI: -0.18 to 0.27 mm). The difference in the marginal bone level changes between immediate and conventional loading was also not statistically significant (SMD = -0.05 mm; 95% CI: -0.15 to 0.06 mm for the mesial site and SMD = -0.02 mm; 95% CI: -0.09 to 0.05 mm for the distal site). Soft tissue changes following immediate and conventional restoration reported no significant differences in the papillae level of the mesial site (SMD = 0.18 mm; 95% CI: -0.00 to 0.37 mm), the papillae level of the distal site (SMD = -0.12 mm; 95% CI: -0.34 to 0.09 mm), and the midbuccal mucosa (SMD = -0.22 mm; 95% CI: -1.29 to 0.85 mm).
CONCLUSION
Within the limitations, it can be concluded that immediately placed, restored, or loaded single-tooth implants in the esthetic zone result in similar hard and soft tissue changes compared with conventional protocols.
Topics: Dental Implantation, Endosseous; Dental Implants, Single-Tooth; Esthetics; Esthetics, Dental; Gingival Recession; Hardness; Humans; Immediate Dental Implant Loading; Maxilla; Mouth Mucosa; Randomized Controlled Trials as Topic
PubMed: 27861657
DOI: 10.11607/jomi.4668 -
Clinical Oral Implants Research Mar 2018Working Group 2 at the 2nd Consensus Meeting of the Osteology Foundation had a focus on the influence of vertical implant placement on papilla height at single implants... (Review)
Review
Evidence-based knowledge on the aesthetics and maintenance of peri-implant soft tissues: Osteology Foundation Consensus Report Part 3-Aesthetics of peri-implant soft tissues.
OBJECTIVES
Working Group 2 at the 2nd Consensus Meeting of the Osteology Foundation had a focus on the influence of vertical implant placement on papilla height at single implants adjacent to teeth and on the inter-implant mucosa fill at two adjacent implants in the anterior maxilla.
MATERIALS AND METHODS
Two systematic reviews were prepared in advance of the consensus meeting. Due to the heterogeneity among the studies with regard to study design, study population, method of assessment, meta-analyses were not possible. Consensus statements, clinical recommendations, and implications for future research were based on structured group discussions until consensus was reached among the entire expert group.
RESULTS
The systematic review about single-tooth implants included a total of 12 studies demonstrating that the vertical distance from the crestal bone level to the base of the interproximal contact point varied considerably from 2 mm up to 11 mm, and a partial or complete papilla fill was reached in 56.5% to 100% of the cases. For the systematic review regarding two adjacent implants, only four studies reported on horizontal inter-implant distances which ranged between 2.0 and 4.0 mm. More than half of the papilla presence was indicated in 21% to 88.5% of the cases.
CONCLUSIONS
It was concluded that for single-tooth implants, the papilla height between an implant and a tooth is predominantly dependent on the clinical attachment level of the tooth. In cases with two adjacent implants, it was concluded that it is not possible to define the optimal horizontal distance between two adjacent implants restored with fixed dental prosthess.
Topics: Alveolar Process; Consensus; Databases, Factual; Dental Abutments; Dental Implantation, Endosseous; Dental Implants; Dental Implants, Single-Tooth; Dental Papilla; Esthetics, Dental; Gingiva; Humans; Maxilla; Osteology
PubMed: 29498131
DOI: 10.1111/clr.13113 -
Materials (Basel, Switzerland) Jul 2022: Immediate implant placement with immediate esthetics has become a more common procedure over time, though ensuring good emergence of the axis of the implant has been a... (Review)
Review
: Immediate implant placement with immediate esthetics has become a more common procedure over time, though ensuring good emergence of the axis of the implant has been a challenge. A novel macroimplant design with an angled platform (Co-Axis) has been developed to ensure exit of the head of the implant in the correct prosthetic position. A systematic literature review was carried to determine the survival rate and marginal bone loss associated with these implants. : An electronic and manual literature search was made in accordance with the PRISMA statement. The search strategy was limited to human studies, retrospective and prospective clinical trials, cross-sectional studies, and cohort studies reporting outcomes of a novel macrohybrid implant with a 12° angled implant connection. : Three articles met the inclusion criteria and were reviewed in the analysis. The estimated success rate was 95.9%. The global marginal bone loss was estimated to be -0.17 ± 0.58 mm in an environment characterized by great heterogeneity (I = 99%). The estimated mean implant stability was 69.6 ± 0.92 (ISQ). As only two studies provided the required information, it was not possible to determine publication bias. Lastly, mean recession was estimated to be practically zero (0.06 ± 0.23 mm), with great heterogeneity. : Within the limitations of this systematic review, it can be affirmed that immediate implant treatment with Co-Axis implants shows a survival rate of 95.9% at one year of follow-up, with low marginal bone loss values, near-zero soft tissue recession, and favorable papilla index values. Nevertheless, the great heterogeneity of the data requires the findings to be interpreted with caution.
PubMed: 35888482
DOI: 10.3390/ma15145011 -
JDR Clinical and Translational Research Apr 2021To systematically review the literature addressing the focused question: What is the effectiveness of different surgical and nonsurgical procedures combined with enamel... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically review the literature addressing the focused question: What is the effectiveness of different surgical and nonsurgical procedures combined with enamel matrix derivative (EMD) on clinical, radiographic, and patient-centered outcomes in intraosseous defects?
METHODS
Electronic (Medline, Scopus, and Cochrane databases) and hand literature searches were performed for studies including at least 1 treatment arm where EMD had been applied according to 1 of the following procedures: modified Widman flap; papilla preservation variants (PPVs), including papilla preservation technique, modified papilla preservation technique, and simplified papilla preservation technique; minimally invasive variants, including minimally invasive surgical approach and minimally invasive surgical technique; single-flap variants (SFVs), including single-flap approach and modified minimally invasive surgical technique; or nonsurgical application (flapless approach). Data from 42 selected articles were used to perform a network meta-analysis, and a hierarchy of surgical and nonsurgical applications of EMD was built separately for EMD and EMD + graft based on 6- to 12-mo clinical and radiographic outcomes.
RESULTS
Among surgical approaches, EMD was associated with best regenerative outcomes when applied through SFVs, with a mean clinical attachment level gain of 3.93 mm and a reduction in the intrabony component of the defect of 3.35 mm. For EMD + graft, limited differences in regenerative outcomes were observed among surgical procedures. PPVs were associated with the highest residual probing depth for EMD (4.08 mm) and EMD + graft (4.32 mm).
CONCLUSIONS
In the treatment of periodontal intraosseous defects, 1) SFVs appear to optimize the regenerative outcomes of EMD; 2) substantial regenerative outcomes can be obtained with SFVs and conservative double flaps (i.e., PPVs and minimally invasive variants) when EMD is combined with a graft; and 3) residual probing depth was higher following PPVs for EMD and EMD + graft.
KNOWLEDGE TRANSFER STATEMENT
The results of the present systematic review and meta-analysis can be used by clinicians to identify the most effective surgical or nonsurgical procedure to treat an intraosseous defect with EMD or EMD + graft. The main findings indicate that when EMD application is indicated, surgical access based on a single flap seems the most appropriate to optimize clinical outcomes. The application of EMD + graft can be effectively combined with single flaps and conservative double flaps.
Topics: Dental Enamel Proteins; Guided Tissue Regeneration, Periodontal; Humans; Minimally Invasive Surgical Procedures; Periodontal Attachment Loss; Surgical Flaps
PubMed: 32559395
DOI: 10.1177/2380084420934731 -
World Journal of Stem Cells Oct 2020The proteomic signature or profile best describes the functional component of a cell during its routine metabolic and survival activities. Additional complexity in...
BACKGROUND
The proteomic signature or profile best describes the functional component of a cell during its routine metabolic and survival activities. Additional complexity in differentiation and maturation is observed in stem/progenitor cells. The role of functional proteins at the cellular level has long been attributed to anatomical niches, and stem cells do not deflect from this attribution. Human dental stem cells (hDSCs), on the whole, are a combination of mesenchymal and epithelial coordinates observed throughout craniofacial bones to pulp.
AIM
To specify the proteomic profile and compare each type of hDSC with other mesenchymal stem cells (MSCs) of various niches. Furthermore, we analyzed the characteristics of the microenvironment and preconditioning changes associated with the proteomic profile of hDSCs and their influence on committed lineage differentiation.
METHODS
Literature searches were performed in PubMed, EMBASE, Scopus, and Web of Science databases, from January 1990 to December 2018. An extra inquiry of the grey literature was completed on Google Scholar, ProQuest, and OpenGrey. Relevant MeSH terms (PubMed) and keywords related to dental stem cells were used independently and in combination.
RESULTS
The initial search resulted in 134 articles. Of the 134 full-texts assessed, 96 articles were excluded and 38 articles that met the eligibility criteria were reviewed. The overall assessment of hDSCs and other MSCs suggests that differences in the proteomic profile can be due to stem cellular complexity acquired from varied tissue sources during embryonic development. However, our comparison of the proteomic profile suffered inconsistencies due to the heterogeneity of various hDSCs. We believe that the existence of a heterogeneous population of stem cells at a given niche determines the modalities of regeneration or tissue repair. Added prominences to the differences present between various hDSCs have been reasoned out.
CONCLUSION
Systematic review on proteomic studies of various hDSCs are promising as an eye-opener for revisiting the proteomic profile and in-depth analysis to elucidate more refined mechanisms of hDSC functionalities.
PubMed: 33178402
DOI: 10.4252/wjsc.v12.i10.1214 -
Medicina Oral, Patologia Oral Y Cirugia... Sep 2017Dental implant placement using flapless surgery is a minimally invasive technique that improves blood supply compared with flapped surgery. However, the flapless... (Review)
Review
BACKGROUND
Dental implant placement using flapless surgery is a minimally invasive technique that improves blood supply compared with flapped surgery. However, the flapless technique does not provide access to allow bone regeneration.
OBJECTIVE
The aim of this systematic review was to evaluate the clinical parameters following implant surgery in healed sites, using two procedures: flapped vs. flapless surgery.
MATERIALS AND METHODS
A detailed electronic search was carried out in the PubMed/Medline, Embase and Cochrane Library databases. The focused question was, "How do flapped and flapless surgical techniques affect the clinical parameters of dental implants placed in healed sites?". All the studies included with a prospective controlled design were considered separately, depending on whether they had been conducted on animals or humans. The following data were recorded in all the included studies: number of implants, failures, location (maxilla, mandible), type of rehabilitation (partial or single), follow-up and flap design. The variables selected for comparison in the animal studies were the following: flap design, gingival index, mucosal height, recession and probing pocket depth. In humans studies the variables were as follows: flap design, plaque index, gingival index, recession, probing pocket depth, papilla index and keratinized gingiva.
RESULTS
Ten studies were included, six were experimental studies and four were clinical studies. Studies in animals showed better results using the flapless technique in the parameters analyzed. There is no consensus in the clinical parameters analyzed in human studies, but there is a trend to better results using flapless approach.
CONCLUSION
The animal studies included in the present review show that implants placed in healed sites with a flapless approach have better clinical parameters than the flapped procedure in a short-term follow-up. In human studies, there is no consensus about which technique offer better results in terms of clinical parameters. Therefore, more research in humans is required in order to overcome the limitations and contrast these results.
Topics: Dental Implantation, Endosseous; Humans; Surgical Flaps
PubMed: 28809375
DOI: 10.4317/medoral.21897 -
Journal of Clinical Medicine Jan 2024: The goal of this systematic study and meta-analysis was to evaluate the efficacy of hard and/or soft tissue grafts associated with type-1 implants on healing and... (Review)
Review
: The goal of this systematic study and meta-analysis was to evaluate the efficacy of hard and/or soft tissue grafts associated with type-1 implants on healing and treatment outcomes. The primary outcomes studied were implant survival rate, pocket depth, marginal peri-implant recession, bone loss, bone thickness (volumetric change), interproximal bone level, mesial and distal papilla migration, and radiographic evaluation; and the secondary parameters were Pink Esthetic Score (PES), vertical distance from implant shoulder and bone, Visual Analogue Score (VAS), Implant Stability Quotient (ISQ), and biological complications (fistulas, pain, mucositis, and peri-implantitis). : The PICO strategy was used to formulate the hypothesis under study: "For patients who underwent extraction and immediate implant placement, what is the efficacy of using any type of graft (bone or soft tissue) compared to non-grafting regarding the peri-implant parameters?" The electronic search process was performed on the MedLine/PubMed and Cochrane databases. It included randomized controlled trials (RCTs) from the last 11 years (from 2012 to November 2023), which were identified and analyzed. : Nine RCTs (κ = 0.98) were selected (403 patients and 425 implants); they were divided into three groups: bone graft (75 patients and 75 implants inserted), bone graft and membrane (213 patients and 235 implants inserted), and without bone graft (115 patients and 115 implants inserted). Three studies calculated the mid-facial mucosa level and two reported better results when a connective tissue graft was combined with the xenograft, whereas another study found better results in the combination of a dual-zone technique with a xenograft. Three studies evaluated the total Pink Esthetic Score (PES) at 12 months, where the authors found no significant difference in using a xenogeneic graft with or without a membrane. In the same period, the facial bone thickness was assessed in two articles; the authors reported better results in graft-treated and flapless groups. The risk-of-bias assessment found four studies with low risk, four with moderate risk, and one with a high risk of bias. The meta-analysis showed a medium level of heterogeneity for the mid-facial mucosa level analysis (I = 46%) and an overall effect size of 0.79 (95% CI [0.18; 1.40]), a statistically significant results ( = 0.01), with a tendency to favor the experimental group. Also, there was a medium level of heterogeneity among studies regarding total PES (I = 45%), with no significant differences between studies ( = 0.91). Homogeneous results (I = 0%) were found among studies analyzing facial bone thickness, favoring the experimental group; the forest plot showed an effect of 0.37 (95% CI [0.25; 0.50]), which was statistically significant ( < 0.00001) for this parameter. : Then, it was possible to conclude that using bone and soft tissue grafting techniques associated with immediate implant placement (IIP), even though they are not fundamental, was a valuable resource to prevent significant tissue reduction, reaching greater bone stability and higher levels in the Pink Esthetic Score (PES) and Visual Analogue Score (VAS).
PubMed: 38337515
DOI: 10.3390/jcm13030821 -
International Journal of Oral and... Nov 2017A better understanding of factors that can lead to papilla formation or recession, such as the type of site where the implant was placed, is of fundamental importance to... (Review)
Review
A better understanding of factors that can lead to papilla formation or recession, such as the type of site where the implant was placed, is of fundamental importance to the aesthetic success of the rehabilitation. The aim of this study was to perform a systematic review of the literature regarding the formation or recession of papilla adjacent to implants placed in fresh, healing or healed sites. The protocol for this study was registered in the PROSPERO database (registration number CRD 42016033784). An electronic search was performed by two independent reviewers who applied the inclusion and exclusion criteria on the PubMed/MEDLINE, Scopus, and Embase databases from January 2005 up to February 2016. The initial screening yielded 1,065 articles, from which 15 were selected for a systematic review after applying the inclusion and exclusion criteria. Nine studies compared fresh and healed sites, four studies compared healing and healed sites, one study compared fresh and healing sites, and one study analysed all three sites. The majority of studies identified by this systematic review showed no difference between groups after the longer follow-up period. The sites where the implants were placed did not have a long-term influence on papilla formation or recession.
Topics: Dental Implantation, Endosseous; Dental Implants; Dental Papilla; Esthetics, Dental; Gingival Recession; Humans; Wound Healing
PubMed: 28521965
DOI: 10.1016/j.ijom.2017.04.018 -
Journal of Periodontology Feb 2016Immediate implantation, despite many advantages, carries a risk of gingival recession, papilla loss, collapse of ridge contour, and other esthetic complications. Soft... (Review)
Review
BACKGROUND
Immediate implantation, despite many advantages, carries a risk of gingival recession, papilla loss, collapse of ridge contour, and other esthetic complications. Soft tissue graft placement combined with immediate implantation may be used to reduce these concerns. This review aims to systematically analyze clinical esthetic outcomes of the immediate implant combined with soft tissue graft (IMITG).
METHODS
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews were used. The electronic search was conducted using MEDLINE (PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from January 1980 to October 2014. Quality assessments of selected articles were performed. Mid-buccal gingival level, interproximal gingival level, facial gingival thickness, gingival ridge dimension, and width of keratinized gingiva were the esthetic outcomes reviewed. Weighted mean difference of mid-buccal gingival level (WDBGL), papilla index score (WDPIS), and width of keratinized gingiva (WDKG) between initial and last measurements were calculated. Other esthetic outcomes were assessed by the descriptive analysis.
RESULTS
Ten studies with a minimum of 6-month follow-up were included, and reported esthetic outcomes were analyzed. Mid-buccal gingival level (WDBGL, 0.07 mm; 95% confidence interval [CI] = -0.44 to 0.59; P = 0.12) and interproximal gingival level did not significantly change after IMITG (WDPIS in the mesial site, 0.31; 95% CI = -0.01 to 0.64; P = 0.06; and WDPIS in the distal site, 0.29; 95% CI = -0.06 to 0.65; P = 0.11). Width of keratinized gingiva significantly increased after IMITG (WDKG, 1.27 mm; 95% CI = -0.08 to 2.46; P = 0.04). Facial gingival thickness and gingival ridge dimension could be increased after IMITG.
CONCLUSIONS
Because of the heterogeneity and limited number of selected studies, no conclusive statement could be made regarding the benefit of IMITG on esthetic outcomes. More randomized controlled trials are needed to provide definite clinical evidence.
Topics: Connective Tissue; Dental Implantation, Endosseous; Dental Implants; Esthetics; Gingiva; Gingival Recession; Humans; Treatment Outcome
PubMed: 26469808
DOI: 10.1902/jop.2015.150383 -
The Journal of Prosthetic Dentistry Jul 2017Esthetic outcomes associated with implant dentistry are important to both clinicians and patients. However, esthetic satisfaction may vary between the 2 groups. In order... (Review)
Review
STATEMENT OF PROBLEM
Esthetic outcomes associated with implant dentistry are important to both clinicians and patients. However, esthetic satisfaction may vary between the 2 groups. In order to evaluate the current publications relating to this topic, the following focused question was developed, "what are the quantitative and qualitative differences between clinician evaluations and patient perspectives in the assessment of single-tooth implant outcomes in the esthetic zone?"
PURPOSE
The purpose of this systematic review was to identify differences in esthetic satisfaction between clinicians and patients when evaluating single-tooth implant-supported restorations.
MATERIAL AND METHODS
An electronic search of the Medline database and Cochrane Central Register of Controlled Trials (2000 to 2014) was performed. The search was supplemented by a manual search of specific journals. A quality assessment of full-text articles was performed according to Cochrane Collaboration's tool and Newcastle-Ottawa scale for risk of bias assessment. Information regarding outcomes was collected and compared.
RESULTS
The search term combinations identified 555 titles. Subsequent to further review, 11 publications, including 2 randomized controlled trials, were selected for inclusion. Because of the heterogeneity of the study designs, study interventions, and esthetic assessment methods, no meta-analysis was performed. The clinicians identified a satisfactory outcome in 51% to 100% for peri-implant soft tissue and 62% to 90% for implant restorations. Patients showed a mean range score of 43% to 93% for peri-implant soft tissue and 81% to 96% for implant restorations. The visual analog scale score of the dentists was always lower than that of the patients. The review identified correlations between subjective and objective assessments for the Pink Esthetic Score (PES), the Papilla Index (PI), the Implant Crown Aesthetic Index (ICAI), and the modified (mod-ICAI) indices.
CONCLUSIONS
Clinicians are more critical of esthetic outcomes than patients. The PES and the PI correlated with the patients' responses concerning the peri-implant soft tissue. The ICAI and the mod-ICAI showed a correlation of both the peri-implant mucosa and implant-supported crown satisfaction. Thus, a comprehensive and practical index should be developed to assess the esthetic outcomes for single-tooth implant restorations in the esthetic zone.
Topics: Crowns; Databases, Factual; Dental Implantation, Endosseous; Dental Implants, Single-Tooth; Dental Prosthesis, Implant-Supported; Esthetics, Dental; Humans; Maxilla; Patient Satisfaction
PubMed: 28385430
DOI: 10.1016/j.prosdent.2016.10.036