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Clinical Oral Implants Research Jan 2022To analyze the clinical outcomes of all-ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To analyze the clinical outcomes of all-ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants.
MATERIALS AND METHODS
Based on a focused question and customized PICO framework, electronic (Medline/EMBASE/Cochrane) and manual searches for studies reporting the clinical outcomes of all-ceramic SCs and FDPs supported by ceramic implants ≥12 months were performed. The primary outcomes were reconstruction survival and the chipping proportion. The secondary outcomes were implant survival, technical complications, and patient-related outcome measurements. Meta-analyses were performed after 1, 2, and 5 years using random-effect meta-analyses.
RESULTS
Eight of the 1,403 initially screened titles and 55 full texts were included. Five reported on monolithic lithium disilicate (LS2) SCs, one on veneered zirconia SCs, and two on veneered zirconia SCs and FDPs, which reported all on cement-retained reconstructions (mean observation: 12.0-61.0 months). Meta-analyses estimated a 5-year survival rate of 94% (95% confidence interval [CI]: 82%-100%) for overall implant survival. Reconstruction survival proportions after 5 years were: monolithic LS2, 100% (95%CI: 95%-100%); veneered zirconia SCs, 89% (95%CI: 62%-100%); and veneered zirconia FDPs 94% (95%CI: 81%-100%). The chipping proportion after 5 years was: monolithic LS2, 2% (95%CI: 0%-11%); veneered zirconia SCs, 38% (95%CI: 24%-54%); and veneered zirconia FDPs, 57% (95%CI: 38%-76%). Further outcomes were summarized descriptively.
CONCLUSIONS
Due to the limited data available, only tendencies could be identified. All-ceramic reconstructions supported by ceramic implants demonstrated promising survival rates after mid-term observation. However, high chipping proportions of veneered zirconia SCs and, particularly, FDPs diminished the overall outcome. Monolithic LS2 demonstrated fewer clinical complications. Monolithic reconstructions could be a valid treatment option for ceramic implants.
Topics: Ceramics; Crowns; Dental Implants; Dental Porcelain; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Humans; Metal Ceramic Alloys; Zirconium
PubMed: 34665900
DOI: 10.1111/clr.13871 -
European Journal of Orthodontics Mar 2022The aim of this systematic review was to compare the different force delivery systems for orthodontic space closure by sliding mechanics. (Meta-Analysis)
Meta-Analysis
BACKGROUND/OBJECTIVES
The aim of this systematic review was to compare the different force delivery systems for orthodontic space closure by sliding mechanics.
SEARCH METHODS
Multiple sources including Cochrane Central, Ovid Medline, Embase etc. were used to identify all relevant studies.
SELECTION CRITERIA
Randomized controlled trials (RCT) of parallel-group and split-mouth designs were included.
PARTICIPANTS
Orthodontic patients of any age treated with fixed orthodontic appliances and requiring space closure.
DATA COLLECTION AND ANALYSIS
Search result screening, data extraction and quality assessment were performed independently and in duplicate by 2 reviewers. The included studies were grouped into parallel-arm and split-mouth studies and subgroup analysis was then performed for the type of retraction subsets; en-masse and individual canine retraction. A traditional meta-analysis, and network meta-analysis (NMA) for direct and indirect comparisons for the rate of space closure were performed.
RESULTS
Thirteen studies, six parallel-arm and seven split-mouth were included. The traditional meta-analysis comparing Nickel-titanium (NiTi) closed coil springs and elastomeric power chain for the rate of tooth movement showed statistically significant difference favouring NiTi springs (MD: 0.24; 95% CI, 0.03-0.45; I2 0%, P = 0.02) and the comparison between NiTi springs and active ligatures also showed statistically significant result favouring NiTi springs (MD: 0.53; 95% CI, 0.44-0.63; I2 0%, P ˂ 0.00001) for the rate of tooth movement. NMA for the rate of space closure showed fairly confident evidence for NiTi coil springs when compared with elastomeric chain and active ligatures. The NiTi coil spring ranked best between all methods of space closure.
CONCLUSIONS
There is moderate quality evidence in favour of NiTi coil springs for the rate of space closure when compared with active ligature and low quality of evidence favouring NiTi springs when compared with elastomeric chain. The ranking from NMA showed NiTi coil springs to be the best method for space closure with 99% chance. An urgent need for standardization of study designs and the need for development of an agreed core outcome sets and core outcome instrument measurement sets is evident.
REGISTRATION
PROSPERO CRD42020157811.
Topics: Dental Alloys; Elasticity; Humans; Orthodontic Space Closure; Orthodontic Wires; Titanium; Tooth Movement Techniques
PubMed: 34609513
DOI: 10.1093/ejo/cjab047 -
Materials (Basel, Switzerland) Sep 2021(1) Background: Hypersensitivity reactions to metals may arise in predisposed patients chronically exposed to metallic materials, including dental implants made of... (Review)
Review
(1) Background: Hypersensitivity reactions to metals may arise in predisposed patients chronically exposed to metallic materials, including dental implants made of titanium alloys. The purpose of this article was to systematically review titanium allergy manifestations in patients treated with dental implants and report a clinical case; (2) Methods: A systematic electronic search was performed for articles published in the English language until July 2021. The following eligibility criteria were adopted: (1) Population: individuals undergoing titanium and/or titanium alloy implant-supported rehabilitations; (2) Exposure: peri-implant soft tissue reactions attributable to implant insertion; (3) Outcome: evidence of titanium allergy, diagnostic methods, and forms of resolution; (3) Results: The included studies, in summary, presented evidence that titanium should not be considered an inert material, being able to trigger allergic reactions, and may be responsible for implant failure. A 55-year-old male patient received 3 implants in the posterior region of the left mandible and presented an epulis-like lesion developed from the peri-implant mucosa. The immunohistochemical analysis of the biopsy specimen confirmed the initial diagnosis of allergic reaction to titanium; (4) Conclusions: Although the evidence is weak, and titanium allergy has a low incidence, hypersensitivity reactions should not be underestimated. A rapid and conclusive diagnosis is mandatory to prevent further complications.
PubMed: 34576463
DOI: 10.3390/ma14185239 -
The Journal of Prosthetic Dentistry Jun 2023High-power laser irradiation may be a promising treatment for titanium dental implant surfaces. However, systematic reviews of the influence of high-power laser... (Review)
Review
STATEMENT OF PROBLEM
High-power laser irradiation may be a promising treatment for titanium dental implant surfaces. However, systematic reviews of the influence of high-power laser irradiation on the different properties of titanium surfaces are lacking.
PURPOSE
The purpose of this systematic review was to analyze the influence of surface treatment by high-power laser irradiation on the surface properties of titanium and its alloys.
MATERIAL AND METHODS
The PubMed, LILACS, COCHRANE library, and Science Direct databases were searched, and articles published in the last 10 years were included. Of the 725 articles initially identified, 27 were selected after full reading and the application of inclusion and exclusion criteria.
RESULTS
The studies evaluated showed that laser irradiation treatment, depending on the settings and parameters used, promoted changes in the surface properties of titanium. In general, lower speed and a higher number of scans increased roughness. Laser surface treatment promoted the inclusion of more oxygen and improved the wetting capacity of titanium. Additionally, laser treatment improved the adherence of coatings.
CONCLUSIONS
Changes in the surface properties of titanium after laser treatment have been demonstrated. However, determining protocols with specific parameters is necessary to optimize the results.
Topics: Titanium; Dental Implants; Microscopy, Electron, Scanning; Surface Properties; Lasers
PubMed: 34493390
DOI: 10.1016/j.prosdent.2021.07.026 -
The Cochrane Database of Systematic... Aug 2021Traditionally, amalgam has been used for filling cavities in posterior teeth, and it continues to be the restorative material of choice in some low- and middle-income... (Review)
Review
BACKGROUND
Traditionally, amalgam has been used for filling cavities in posterior teeth, and it continues to be the restorative material of choice in some low- and middle-income countries due to its effectiveness and relatively low cost. However, there are concerns over the use of amalgam restorations (fillings) with regard to mercury release in the body and the environmental impact of mercury disposal. Dental composite resin materials are an aesthetic alternative to amalgam, and their mechanical properties have developed sufficiently to make them suitable for restoring posterior teeth. Nevertheless, composite resin materials may have potential for toxicity to human health and the environment. The United Nations Environment Programme has established the Minamata Convention on Mercury, which is an international treaty that aims "to protect the [sic] human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds". It entered into force in August 2017, and as of February 2021 had been ratified by 127 governments. Ratification involves committing to the adoption of at least two of nine proposed measures to phase down the use of mercury, including amalgam in dentistry. In light of this, we have updated a review originally published in 2014, expanding the scope of the review by undertaking an additional search for harms outcomes. Our review synthesises the results of studies that evaluate the long-term effectiveness and safety of amalgam versus composite resin restorations, and evaluates the level of certainty we can have in that evidence.
OBJECTIVES
To examine the effects (i.e. efficacy and safety) of direct composite resin fillings versus amalgam fillings.
SEARCH METHODS
An information specialist searched five bibliographic databases up to 16 February 2021 and used additional search methods to identify published, unpublished and ongoing studies SELECTION CRITERIA: To assess efficacy, we included randomised controlled trials (RCTs) comparing dental composite resin with amalgam restorations in permanent posterior teeth that assessed restoration failure or survival at follow-up of at least three years. To assess safety, we sought non-randomised studies in addition to RCTs that directly compared composite resin and amalgam restorative materials and measured toxicity, sensitivity, allergy, or injury.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane.
MAIN RESULTS
We included a total of eight studies in this updated review, all of which were RCTs. Two studies used a parallel-group design, and six used a split-mouth design. We judged all of the included studies to be at high risk of bias due to lack of blinding and issues related to unit of analysis. We identified one new trial since the previous version of this review (2014), as well as eight additional papers that assessed safety, all of which related to the two parallel-group studies that were already included in the review. For our primary meta-analyses, we combined data from the two parallel-group trials, which involved 1645 composite restorations and 1365 amalgam restorations in 921 children. We found low-certainty evidence that composite resin restorations had almost double the risk of failure compared to amalgam restorations (risk ratio (RR) 1.89, 95% confidence interval (CI) 1.52 to 2.35; P < 0.001), and were at much higher risk of secondary caries (RR 2.14, 95% CI 1.67 to 2.74; P < 0.001). We found low-certainty evidence that composite resin restorations were not more likely to result in restoration fracture (RR 0.87, 95% CI 0.46 to 1.64; P = 0.66). Six trials used a split-mouth design. We considered these studies separately, as their reliability was compromised due to poor reporting, unit of analysis errors, and variability in methods and findings. Subgroup analysis showed that the findings were consistent with the results of the parallel-group studies. Three trials investigated possible harms of dental restorations. Higher urinary mercury levels were reported amongst children with amalgam restorations in two trials, but the levels were lower than what is known to be toxic. Some differences between amalgam and composite resin groups were observed on certain measures of renal, neuropsychological, and psychosocial function, physical development, and postoperative sensitivity; however, no consistent or clinically important harms were found. We considered that the vast number of comparisons made false-positive results likely. There was no evidence of differences between the amalgam and composite resin groups in neurological symptoms, immune function, and urinary porphyrin excretion. The evidence is of very low certainty, with most harms outcomes reported in only one trial.
AUTHORS' CONCLUSIONS
Low-certainty evidence suggests that composite resin restorations may have almost double the failure rate of amalgam restorations. The risk of restoration fracture does not seem to be higher with composite resin restorations, but there is a much higher risk of developing secondary caries. Very low-certainty evidence suggests that there may be no clinically important differences in the safety profile of amalgam compared with composite resin dental restorations. This review supports the utility of amalgam restorations, and the results may be particularly useful in parts of the world where amalgam is still the material of choice to restore posterior teeth with proximal caries. Of note, however, is that composite resin materials have undergone important improvements in the years since the trials informing the primary analyses for this review were conducted. The global phase-down of dental amalgam via the Minamata Convention on Mercury is an important consideration when deciding between amalgam and composite resin dental materials. The choice of which dental material to use will depend on shared decision-making between dental providers and patients in the clinic setting, and local directives and protocols.
Topics: Bias; Child; Composite Resins; Dental Amalgam; Dental Caries; Dentition, Permanent; Humans; Randomized Controlled Trials as Topic
PubMed: 34387873
DOI: 10.1002/14651858.CD005620.pub3 -
The Journal of Prosthetic Dentistry Oct 2022Selective laser melting (SLM) additive manufacturing (AM) technologies provide an alternative to conventional casting and milling procedures in fabricating metal-ceramic... (Meta-Analysis)
Meta-Analysis Review
Adhesion of veneering porcelain to cobalt-chromium dental alloys processed with casting, milling, and additive manufacturing methods: A systematic review and meta-analysis.
STATEMENT OF PROBLEM
Selective laser melting (SLM) additive manufacturing (AM) technologies provide an alternative to conventional casting and milling procedures in fabricating metal-ceramic dental prostheses. However, the quality of porcelain bond strength to the SLM AM cobalt-chromium (Co-Cr) metal framework of a dental restoration is unclear.
PURPOSE
The purpose of this systematic review and meta-analysis was to identify in vitro studies that reported the porcelain bond strength to SLM AM Co-Cr dental metal alloys and compare the porcelain bond strength values to cast, milled, and additively manufactured Co-Cr dental alloys.
MATERIAL AND METHODS
An electronic systematic review was performed in different databases: MEDLINE/PubMed, EMBASE, World of Science, Cochrane, and Scopus. A manual search was also conducted. Studies that reported the porcelain bond strength to SLM Co-Cr metal alloys and in the English language were included. Two investigators evaluated the quality assessment of the studies by applying the JBI critical appraisal checklist for quasi-experimental studies (nonrandomized experimental studies). A third investigator was consulted to resolve lack of consensus. Two subgroups were created based on the test used, 3-point bend and shear bond strength tests. The porcelain bond strength of cast, milled, and AM Co-Cr dental alloys were compared. The I2 statistic and its associated P value were used to assess the heterogeneity between studies. The Eger test was used for determining significance of the funnel pots.
RESULTS
A total of 216 studies were collected from the electronic and manual searches. After independently evaluating the titles and abstracts by the reviewers, 26 articles were identified. Three of these were excluded after full-text revision. The porcelain bond strength comparison between the cast and AM alloys for the 3-point bend subgroup revealed a significant result for overall effect (P<.001) favoring the SLM method with considerable heterogeneity (I2=83%, P<.001). Furthermore, the porcelain bond strength comparison between cast and milled alloys for the shear bond strength subgroup revealed a significant test for overall effect (P=.04) favoring milled procedures with a nonsignificant unimportant heterogeneity (I2= 0%, P<.47) and for the 3-point bend subgroup (P<.001) favoring milled specimens with a significant considerable heterogeneity (I2=79%, P<.001).
CONCLUSIONS
The metal manufacturing method had no effect on the porcelain bond strength to Co-Cr dental metal alloys.
Topics: Dental Porcelain; Chromium Alloys; Metal Ceramic Alloys; Dental Bonding; Materials Testing; Surface Properties; Cobalt; Chromium; Dental Alloys
PubMed: 34294418
DOI: 10.1016/j.prosdent.2021.01.001 -
The Journal of Contemporary Dental... Apr 2021The aim of this systemic review is to investigate these parameters by analyzing the characteristics of fractured instruments to determine which is the most relevant...
AIM
The aim of this systemic review is to investigate these parameters by analyzing the characteristics of fractured instruments to determine which is the most relevant mechanical stress that induces intracanal separation .
BACKGROUND
The fracture of nickel-titanium (Ni-Ti) instruments is a result of flexural fatigue and torsional fatigue. An electronic search was conducted in MEDLINE database, Web of Science, and Cochrane following preferred reporting items for systematic reviews and meta-analyses guidelines. Data were collected and the key features from the included studies were extracted. Overview quality assessment questionnaire scoring assessed the quality of the articles. A total of 12 articles were selected, where the lowest score was 13.
REVIEW RESULTS
Considering Ni-Ti rotary instruments, this overall evaluation comprehends 939 broken instruments with an incidence of fracture of 5%. Out of the 12 selected articles, 10 studies revealed that flexural failure was the predominant mode (range of 62-92%). It appears that motion plays an important role when it comes to mechanisms of fracture. The majority of defects found in hand-operated instruments were in the form of torsional failure. Although the major cause of separation of rotary instruments is flexural fatigue, smaller instruments show more torsional fracture than the larger instruments. The average fragment length was found to be 2.5 mm and 3.35 mm, respectively, for torsional failure and flexural failure. The risk of bias depends on fractographic analysis.
CONCLUSION
Flexural fatigue is the predominant mode of fracture in rotary Ni-Ti instruments. The type of motion and size of the instrument seem to affect the mechanism of fracture. Fragment length may show a strong association with the type of fracture mechanism.
CLINICAL SIGNIFICANCE
This systemic review found that flexural fatigue is the most relevant mechanical stress that induces intracanal separation . Moreover, in clinical practice, the fragment length might be an excellent indicator of the type of fracture.
Topics: Dental Alloys; Dental Instruments; Equipment Design; Equipment Failure; Incidence; Nickel; Root Canal Preparation; Stress, Mechanical; Titanium; Torsion, Mechanical
PubMed: 34267014
DOI: No ID Found -
Materials (Basel, Switzerland) Jun 2021The purpose of this systematic review was to investigate the clinical outcomes of frameworks made of different materials in patients with implant-supported full-arch... (Review)
Review
The purpose of this systematic review was to investigate the clinical outcomes of frameworks made of different materials in patients with implant-supported full-arch prostheses. A literature search was conducted on MEDLINE, Scopus and Cochrane Library, until the 1st of March 2021, with the following search terms: framework or substructure combined with "dental implants". The outcomes evaluated were: implant and prosthesis survival, bone resorption, biological and technical complications. The Cochrane Handbook for Systematic Reviews of Interventions was employed to assess the risk of bias in randomized clinical trials. The Newcastle-Ottawa quality assessment scale was used for non-randomized studies. In total, 924 records were evaluated for title and abstract, and 11 studies were included in the review: 4 clinical randomized trials and 7 cohort studies. The framework materials investigated were: gold alloy, titanium, silver-palladium alloy, zirconia and polymers including acrylic resin and carbon-fiber-reinforced composites. High implant and prosthetic cumulative survival rates were recorded by all included studies. Various materials and different fabrication techniques are now available as alternatives to traditional cast metal frameworks, for full-arch implant-supported rehabilitations. Further long-term studies are needed to validate the use of these materials and clarify their specific clinical indications and manufacturing protocols to optimize their clinical outcomes.
PubMed: 34204681
DOI: 10.3390/ma14123251 -
Clinical and Experimental Dental... Dec 2021Grade V titanium alloy (Ti-6Al-4 V) is a well-recognized metallic biomaterial for medical implants. There has been some controversy regarding the use of this alloy in... (Review)
Review
OBJECTIVES
Grade V titanium alloy (Ti-6Al-4 V) is a well-recognized metallic biomaterial for medical implants. There has been some controversy regarding the use of this alloy in medical devices in relation to the toxicity of vanadium. In Dentistry, Ti-6Al-4 V remains prevalent. This systematic review aims to evaluate the effects of Ti-6Al-4 V on cells relevant to oral environments such as gingival fibroblasts.
MATERIALS AND METHODS
A literature search was undertaken for relevant English language publications in the following databases: Dental and Oral Science, Medline and Web of Science. The electronic search was supplemented with a search of references.
RESULTS
After application of inclusion and exclusion criteria. A total of eight papers are included in this review. These papers were all in vitro studies and were categorized into whole implant, discs, or implant particles based on the type of test materials used in the studies.
CONCLUSION
Based on the analyses of the eight included studies in this review, if Ti-6Al-4 V as a material is unchallenged, i.e., as a whole implant in pH neutral environments, there appears to be little effect on fibroblasts. If Ti-6Al-4 V is challenged through corrosion or wear (particle release), the subsequent release of vanadium and aluminium particles has an increased cytotoxic effect in vitro in comparison to commercially pure titanium, hence concerns should be raised in the clinical setting.
Topics: Alloys; Dental Implants; Fibroblasts; Materials Testing; Titanium
PubMed: 34018703
DOI: 10.1002/cre2.444 -
Clinical Oral Investigations Jul 2021Microsurgical principles, techniques, and armamentarium have made significant contributions to the periodontal plastic surgery. The present meta-analysis aimed to... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Microsurgical principles, techniques, and armamentarium have made significant contributions to the periodontal plastic surgery. The present meta-analysis aimed to investigate the overall efficacy of microsurgery on root coverage, and its clinical outcomes when compared to traditional macrosurgery.
MATERIAL AND METHODS
Electronic searches on PubMed, Embase, and CINAHL were used to retrieve prospective clinical trials. Primary outcomes were the mean root coverage (mRC) and probability of achieving complete root coverage (cRC), with secondary outcomes as other periodontal parameters and patient-reported outcome measures (PROMs).
RESULTS
Nineteen studies were included in the quantitative analysis. Microsurgery was estimated to achieve 83.3% mRC and 69.3% cRC. From a subgroup of 9 comparative studies, it was estimated microsurgery increased mRC by 6.6% (p<0.001) and cRC by 27.9% (p<0.01) compared to macrosurgical control treatments. Operating microscope (OM) yielded a significantly 6.7% higher mRC than the control group (p=0.002), while using loupes showed 6.16% increase in mRC with a borderline significance (p=0.09). OM and loupes-only had a 31.05% (p=0.001) and 25.54% (p=0.001) increases in achieving cRC compared to control, respectively. As for PROMs, microsurgery reduced postoperative pain (p<0.001) and enhanced esthetics (p= 0.05).
CONCLUSIONS
Microsurgery significantly improved mean root coverage, probability of achieving complete root coverage, esthetics, and post-surgical recovery. Microsurgery enhances not only subclinical healing but also clinical outcomes, possibly owing to its minimally invasive approach and surgical precision.
CLINICAL RELEVANCE
Periodontal plastic microsurgery is minimally invasive, inducing less surgical trauma and ultimately resulting in improved clinical outcomes, patient's satisfaction, and quality of life.
Topics: Connective Tissue; Esthetics, Dental; Gingiva; Gingival Recession; Humans; Microsurgery; Prospective Studies; Quality of Life; Surgical Flaps; Tooth Root; Treatment Outcome
PubMed: 33928441
DOI: 10.1007/s00784-021-03954-0