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Clinical Oral Implants Research Sep 2015The objective of this review was to analyze research with regard to the effect of zirconia or titanium as abutment material on soft peri-implant tissues. (Meta-Analysis)
Meta-Analysis Review
AIM
The objective of this review was to analyze research with regard to the effect of zirconia or titanium as abutment material on soft peri-implant tissues.
METHODS
Clinical studies were selected via electronic and hand searches in English language journals until December 1, 2014. Only randomized clinical trials (RCTs) and prospective controlled clinical trials (CCTs) showing direct comparison between zirconia (Zr) and titanium (Ti) abutments in the same patient were considered. The outcome measures were (1) soft tissue color, (2) soft tissue recession, (3) peri-implant probing, (4) bleeding on probing, (5) esthetic indexes, (6) patient-reported outcome, (7) marginal bone level, and (8) biological complications.
RESULTS
Nine relevant studies (11 papers) were identified: 4 RCTs and 5 CCTs. Due to heterogeneity in the study design, statistical methods, and reported results, a meta-analysis of the data was feasible only for soft tissue color. The outcome was found to be significantly superior for Zr abutments. For the other outcome measures, a qualitative analysis of the selected articles was performed. The studies did not show any statistically significant differences between Zr and Ti abutments on soft tissue recession, probing depths, bleeding on probing, marginal bone level, and patient-reported outcome. One study reported significantly higher pink esthetic score (PES) scores at Zr implants with Zr abutments, compared to metal implants and Ti abutments.
CONCLUSION
Overall, the research does not support any obvious advantage of Ti or Zr abutments over each other. However, there is a significant tendency in Zr abutments evoking better color response of peri-implant mucosa and superior esthetic outcome measured by PES score.
Topics: Dental Abutments; Dental Implants; Esthetics, Dental; Gingiva; Gingival Diseases; Humans; Titanium; Zirconium
PubMed: 26073346
DOI: 10.1111/clr.12631 -
Medicina Oral, Patologia Oral Y Cirugia... Mar 2019The aim of this study was to determine if the treatment with bisphosphonates other anti-resorptive and antiangiogenic agents influences the success of regenerative and /...
BACKGROUND
The aim of this study was to determine if the treatment with bisphosphonates other anti-resorptive and antiangiogenic agents influences the success of regenerative and / or implant treatments.
MATERIAL AND METHODS
We reviewed the literature from the last 5 years in the PubMed database, using the following words: "Sinus Floor Augmentation"[Mesh] OR "Dental Implants"[Mesh]) OR "Guided Tissue Regeneration"[Mesh]) AND "Osteonecrosis"[Mesh]. The articles were selected following the inclusion and exclusion criteria and were evaluated using the 22 items of the STROBE declaration. The following PICO clinical question was applied: Does the treatment with agents associated with drug osteonecrosis influence the success of regenerative and implant treatments?
RESULTS
The initial search resulted in a total of 27 articles. After eliminating those that did not refer to the topic, were duplicated or did not meet the inclusion / exclusion criteria, a full reading of the articles was made evaluating their methodological quality, obtaining six studies with high methodological quality and two with moderate.
CONCLUSIONS
The literature regarding this topic is scarce, randomized clinical trials would be necessary to establish protocols relative to implant treatment in patients on antiresorptive treatments. The risk of developing an osteonecrosis associated with the regeneration / implant placement in patients with benign bone diseases is scarce, but it exists and it should not be underestimated. Especially, in the posterior areas of the jaw, if the duration of treatment with BP is greater than 3 years, and if the patient is under therapy with systemic corticosteroids.
Topics: Animals; Antibodies, Monoclonal; Bone Regeneration; Databases, Factual; Dental Implantation, Endosseous; Dental Implants; Dental Restoration Failure; Diphosphonates; Drug Antagonism; Humans; Osteonecrosis; Sinus Floor Augmentation
PubMed: 30818312
DOI: 10.4317/medoral.22691 -
Journal of Plastic, Reconstructive &... Dec 2023The impact of neoadjuvant chemotherapy (NACT) on the complication rate after implant-based and autologous breast reconstruction remains unclear. The aim of this study... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The impact of neoadjuvant chemotherapy (NACT) on the complication rate after implant-based and autologous breast reconstruction remains unclear. The aim of this study was to systematically review and perform a meta-analysis of previously published studies on immediate breast reconstruction (IBR) in breast cancer patients treated with NACT compared with controls.
METHODS
PubMed and EMBASE were searched to identify studies assessing the impact of NACT on major and minor complications after IBR. The primary effect measures were relative risk (RR), 95% confidence interval (95% CI), and p-value.
RESULTS
Eight studies comprising 51,731 patients were included in the meta-analysis. Of these, 5161 patients received NACT and 46,570 patients did not receive NACT. In regard to major complications, NACT did not statistically significant increase the rate of reconstructive failure (RR = 1.35, 95% CI = 0.96-1.91, p = 0.09), the rate of mastectomy skin-flap necrosis (RR = 1.39, 95% CI = 0.61-3.17, p = 0.44), or the rate of reoperation (RR = 1.09, 95% CI = 0.87-1.37, p = 0.45). Regarding minor complications, NACT did not significantly increase the rate of wound complications (RR = 1.05, 95% CI = 0.87-1.28, p = 0.62). In a subgroup analysis of implant-based breast reconstruction following NACT, single-stage direct-to-implant (DTI) had a significantly lower implant failure rate compared with two-staged tissue expander/implant (TE/I) (RR = 0.43, 95% CI = 0.26-0.71, p = 0.0011).
CONCLUSION
NACT did not increase the major or minor complication rate after IBR with either autologous tissue or implants. Thus, NACT and IBR should be considered safe procedures. The review of studies describing patients undergoing implant-based breast reconstruction following NACT could indicate that single-stage DTI was a safer procedure than two-staged TE/I. However, the association requires further evaluation.
Topics: Humans; Female; Mastectomy; Neoadjuvant Therapy; Breast Neoplasms; Mammaplasty; Postoperative Complications; Treatment Outcome; Breast Implants; Retrospective Studies
PubMed: 37804643
DOI: 10.1016/j.bjps.2023.09.048 -
Journal of Biomedical Materials... Nov 2021Additive manufacturing (AM) of high temperature polymers, specifically polyaryletherketones (PAEK), is gaining significant attention for medical implant applications. As...
Additive manufacturing (AM) of high temperature polymers, specifically polyaryletherketones (PAEK), is gaining significant attention for medical implant applications. As 3D printing systems evolve toward point of care manufacturing, research on this topic continues to expand. Specific regulatory guidance is being developed for the safe management of 3D printing systems in a hospital environment. PAEK implants can benefit from many advantages of AM such as design freedom, material and antibacterial drug incorporation, and enhanced bioactivity provided by cancellous bone-like porous designs. In addition to AM PAEK bioactivity, the biomechanical strength of 3D printed implants is crucial to their performance and thus widely studied. In this review, we discuss the printing conditions that have been investigated so far for additively manufactured PAEK implant applications. The effect of processing parameters on the biomechanical strength of implants is summarized, and the bioactivity of PAEKs, along with material and drug incorporation, is also covered in detail. Finally, the therapeutic areas in which 3D printed PAEK implants are investigated and utilized are reviewed.
Topics: Biocompatible Materials; Bone Substitutes; Humans; Osseointegration; Polymers; Porosity; Printing, Three-Dimensional; Prostheses and Implants
PubMed: 33856114
DOI: 10.1002/jbm.b.34845 -
Orthopaedics & Traumatology, Surgery &... Apr 2023Atypical periprosthetic/peri-implant fractures are not recognised in any widely used classification and therefore little focus is given to them. Multiple case reports... (Meta-Analysis)
Meta-Analysis
Is bisphosphonate use a risk factor for atypical periprosthetic/peri-implant fractures? - A metanalysis of retrospective cohort studies and systematic review of the current evidence.
INTRODUCTION
Atypical periprosthetic/peri-implant fractures are not recognised in any widely used classification and therefore little focus is given to them. Multiple case reports and case series demonstrate these fractures exist and are related to bisphosphonate (BP) use.
HYPOTHESIS
Are patients taking long-term BPs at an increased risk of developing an atypical periprosthetic/peri-implant fracture? Is a particular BP drug causing an increased risk of fracture? Is there a correlation between the time of BP use and the incidence of fractures? Do vitamin D analogues or parathyroid hormones reduce the time to union?
MATERIAL AND METHODS
Systematic review of all available evidence on the existence of periprosthetic/peri-implant atypical fractures in patients taking long-term BPs and metanalysis of available retrospective cohort studies. Selected 1 systematic review, 7 retrospective cohort studies (5 used for metanalysis) and 32 case reports.
RESULTS
Metanalysis reported a risk ratio of 14.1, p=0.25, suggesting bisphosphonates are a risk factor in the development of periprosthetic/peri-implant atypical fractures. The secondary outcomes couldn't be reliably identified due to the small size of available studies and risk of significant bias.
DISCUSSION
Atypical periprosthetic/peri-implant fractures are an entity and seem to be associated with the use of bisphosphonates. The benefits of bisphosphonates use outweigh the risks, but clinicians should be aware of atypical fractures and actively search for them when patients on long-term bisphosphonates attend with non-specific pain close to the implant/prosthesis or reduced mobility.
LEVEL OF EVIDENCE
II, Systematic review and metanalysis.
Topics: Humans; Diphosphonates; Femoral Fractures; Periprosthetic Fractures; Retrospective Studies; Risk Factors
PubMed: 36347461
DOI: 10.1016/j.otsr.2022.103475 -
International Journal of Oral and... Apr 2017Nicotine has been associated with vasoconstriction and an impaired cellular healing response. It is therefore likely that nicotine jeopardizes osseointegration. This... (Meta-Analysis)
Meta-Analysis Review
Nicotine has been associated with vasoconstriction and an impaired cellular healing response. It is therefore likely that nicotine jeopardizes osseointegration. This systematic review and meta-analysis was performed to assess pre-clinical studies on the effect of nicotine on implant osseointegration. Databases were searched up to and including March 2016 for animal/non-human studies using the following Keywords: bone to implant contact; implant; nicotine; osseointegration; bone healing; and new bone formation. In total eight in vivo design studies were included and processed for data extraction. Five studies reported no significant influence of nicotine on healing around implants. Quantitative analysis of the effects of nicotine on the osseointegration of dental implants showed a significant difference in bone-to-implant contact between test and control subjects (Z=-2.49; P=0.014). From the studies included in the present review; it appears that nicotine has an effect on implant osseointegration.
Topics: Animals; Dental Implantation, Endosseous; Dental Implants; Nicotine; Osseointegration; Osteogenesis; Wound Healing
PubMed: 28189374
DOI: 10.1016/j.ijom.2016.12.003 -
Oxidative Medicine and Cellular... 2022Peri-implant mucositis (PiM) is characterized as a reversible inflammatory change of the peri-implant soft tissues without alveolar bone loss or continuing marginal bone... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Peri-implant mucositis (PiM) is characterized as a reversible inflammatory change of the peri-implant soft tissues without alveolar bone loss or continuing marginal bone loss. Without proper control of PiM, the reversible inflammation may advance to peri-implantitis (PI). Mechanical debridement (MD) by the implant surface is the most common and conventional nonsurgical approach to treat PiM but with limitations in complete resolution of diseases. For more than a decade, chlorhexidine (CHX) and active compounds has been investigated in the treatment of PiM. Therefore, the aim of this systematic review and meta-analysis was to evaluate the efficacy of CHX treatment in combination with MD versus MD alone or MD+placebo in patients with PiM on their oral health problems.
METHODS
A search using electronic databases (Ovid MEDLINE, EMBASE, Science Direct databases, and Cochrane Central Register of Controlled Trials) and a manual search up to May 2022 were performed independently by 2 reviewers and included eligible randomized controlled trials (RCTs) comparing MD+CHX versus MD alone or MD+placebo. The assessment of quality for all the selected RCTs was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. Disease resolution of PiM (absence of BOP), IPPD reduction, IBOP% reduction, and PI% reduction after treatment as primary outcomes were selected as the primary outcomes. Weighted mean differences (WMD) and 95% confidence interval (CI) were for continuous outcomes, and odds ratio (OR) and 95% CI was for dichotomous outcomes using random effect models. This review is registered on the PROSPERO database (CRD42020221989).
RESULTS
After independent screening, nine eligible studies were included in this systematic review and meta-analysis. Meta-analysis showed OR of disease resolution between test and control groups amounted to 1.41 (95% CI (0.43, 4.65), = 0.57, = 65%) not favoring adjunctive CHX treatment over MD alone. Through subgroup analysis, the results indicated that oral irrigation of CHX may have more benefits on the resolution of PiM. Similarly, CHX did not significantly improve IPPD reduction at both short-, medium-, and long-term follow-up. Only a short-term effect has been observed at IBOP% reduction (WMD = 13.88, 95% CI (10.94, 16.81), < 0.00001, = 9%), IPI reduction (WMD = 0.12, 95% CI (0.09, 0.14), < 0.00001, = 0%), and FMPPD reduction (WMD = 0.19 mm, 95% CI (0.03, 0.35), = 0.02, = 0%) with adjunctive CHX application.
CONCLUSION
Adjunctive CHX application may have some benefits to improve the efficacy of MD in PiM treatment by reducing IBOP%, IPI, and FMPPD in short-term. But these benefits disappeared at medium- and long-term follow-up. In order to achieve better disease resolution of PiM, adjunctive CHX irrigation with MD may be suggested and has positive potential. Well-designed large clinical trials are needed in future.
Topics: Chlorhexidine; Humans; Mucositis; Oral Health; Peri-Implantitis
PubMed: 36065438
DOI: 10.1155/2022/2312784 -
Lasers in Medical Science Oct 2022Antimicrobial photodynamic therapy (aPDT) has been proposed as an adjunctive treatment strategy for peri-implant diseases. This systematic review aimed to determine... (Meta-Analysis)
Meta-Analysis Review
Antimicrobial photodynamic therapy (aPDT) has been proposed as an adjunctive treatment strategy for peri-implant diseases. This systematic review aimed to determine whether aPDT as an adjunct to mechanical debridement has an additional benefit for smokers with peri-implant diseases. Randomized controlled trials (RCTs), which evaluated the clinical outcomes of mechanical debridement alone versus mechanical debridement + aPDT among smokers, were considered eligible to be included. The primary outcome was bleeding on probing (BOP) and secondary outcomes included probing depth (PD), plaque index (PI), and crestal bone loss (CBL). Meta-analyses using a random-effects model were conducted to calculate the mean difference (MD) with a 95% confidence interval (CI). The quality of evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of four RCTs (188 participants) were included. The aPDT group showed significantly improved PD (MD = - 1.26, 95% CI = - 2.19 to - 0.32, p = 0.008) and PI (MD = - 10.6%, 95% CI = - 14.46 to - 6.74%, p = 0.0001) compared with mechanical debridement group at 3-month follow-up. No significant difference in bleeding on probing (BOP) was observed at 3-month follow-up (MD = - 0.60%, 95% CI = - 2.36 to 1.16%, p = 0.50). The subgroup analyses on photosensitizers demonstrated significant differences between the two groups on PD (MD = - 1.23, 95% CI = - 2.41 to - 0.05, p = 0.04) and PI (MD = - 12.33, 95% CI = - 14.74 to - 9.92, p < 0.00001) by the use of methylene blue (MB). Within the limitation of this study, compared with mechanical debridement alone, combined use of aPDT was more effective in reducing PD and PI in smokers at 3-month follow-up. MB was a predictable photosensitizer for aPDT. However, the findings should be interpreted with caution due to the limited number of included studies, methodological deficiencies, and heterogeneity between studies.
Topics: Anti-Bacterial Agents; Anti-Infective Agents; Combined Modality Therapy; Debridement; Humans; Methylene Blue; Peri-Implantitis; Photochemotherapy; Photosensitizing Agents; Smokers
PubMed: 35896900
DOI: 10.1007/s10103-022-03592-2 -
International Journal of Oral and... May 2022Sinus graft infections are rare but serious complications, as they are associated with significant morbidity and sinus graft loss. The aim of this study was to... (Review)
Review
Sinus graft infections are rare but serious complications, as they are associated with significant morbidity and sinus graft loss. The aim of this study was to systematically review the management of sinus graft infection in order to define which protocols should be implemented. The terms searched in each database were "sinus graft infection management", "maxillary sinus lift infection", "maxillary sinus graft infection", "maxillary sinus elevation infection", and "maxillary sinus augmentation infection". The management of the sinus graft infection was assessed. The outcomes evaluated were maxillary sinus health and dental implantation results. The initial search yielded 1190 results. Eighteen articles were included, reporting a total of 3319 patients and 217 sinus graft infections. Drainage was performed with an intraoral approach in 13 studies, an endoscopic approach in two studies, and a combined approach in three studies. In every study, a disease-free sinus was finally obtained in all patients, but the outcomes of the graft and the dental implant were more varied. It is not possible to define the best treatment protocol for sinus graft infections based on the published data, since the level of evidence is poor. Management is very heterogeneous. This review highlights the necessity of surgical treatment associated with antibiotic therapy.
Topics: Bone Transplantation; Dental Implantation, Endosseous; Dental Implants; Humans; Maxillary Sinus; Maxillary Sinusitis; Postoperative Complications; Sinus Floor Augmentation; Sinusitis
PubMed: 34556376
DOI: 10.1016/j.ijom.2021.09.007 -
Dental Materials Journal 2016Biofilm formation on dental implant surfaces is a serious threat. Up to 50% of all implants show signs of irreversible tissue destruction. The aim of the present... (Review)
Review
Biofilm formation on dental implant surfaces is a serious threat. Up to 50% of all implants show signs of irreversible tissue destruction. The aim of the present systematic review was to summarize the state of the art of strategies to functionalize antimicrobial dental implant surfaces. We searched the following electronic database: SCOPUS, MEDLINE and GOOGLE SCHOLAR and identified relevant controlled trials that evaluated the efficiency of new biomaterial strategies to modify dental implant surfaces, in such a way that biofilm formation was inhibited. The search yielded 2,990 potentially relevant publications. A total of 142 publications met the inclusion criteria. Analysis found that it may be concluded that silver-implanted surfaces, drug-loaded surfaces, surfaces with antimicrobial peptides, bioactive and biopassive polymer coatings as well as nanoscale or UV-activatable surfaces enhance antimicrobial activity compared to commercial pure titanium.
Topics: Anti-Infective Agents; Dental Implantation, Endosseous; Dental Implants; Titanium
PubMed: 27477219
DOI: 10.4012/dmj.2015-314