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Materials (Basel, Switzerland) Feb 2020Blood clot formation in the apical third of the root canal system has been shown to promote further root development and reinforcement of dentinal walls by the... (Review)
Review
Viability and Stimulation of Human Stem Cells from the Apical Papilla (hSCAPs) Induced by Silicate-Based Materials for Their Potential Use in Regenerative Endodontics: A Systematic Review.
Blood clot formation in the apical third of the root canal system has been shown to promote further root development and reinforcement of dentinal walls by the deposition of mineralized tissue, resulting in an advancement from traditional apexification procedures to a regenerative endodontic treatment (RET) for non-vital immature permanent teeth. Silicate-based hydraulic biomaterials, categorized as bioactive endodontic cements, emerged as bright candidates for their use in RET as coronal barriers, sealing the previously induced blood clot scaffold. Human stem cells from the apical papilla (hSCAPs) surviving the infection may induce or at least be partially responsible for the regeneration or repair shown in RET. The aim of this study is to present a qualitative synthesis of available literature consisting of in vitro assays which analyzed the viability and stimulation of hSCAPs induced by silicate-based hydraulic biomaterials. A systematic electronic search was carried out in Medline, Scopus, Embase, Web of Science, Cochrane and SciELO databases, followed by a study selection, data extraction, and quality assessment following the PRISMA protocol. In vitro studies assessing the viability, proliferation, and/or differentiation of hSCAPs as well as their mineralization potential and/or osteogenic, odontogenic, cementogenic and/or angiogenic marker expression in contact with commercially available silicate-based materials were included in the present review. The search identified 73 preliminary references, of which 10 resulted to be eligible for qualitative synthesis. The modal materials studied were ProRoot MTA and Biodentine. Both bioceramic materials showed significant positive results when compared to a control for hSCAP cell viability, migration, and proliferation assays; a significant up-regulation of hSCAP odontogenic/osteogenic marker (ALP, DSPP, BSP, Runx2, OCN, OSX), angiogenic growth factor (VEGFA, FIGF) and pro-inflammatory cytokine (IL-1α, IL-1β, IL-6, TNF-α) expression; and a significant increase in hSCAP mineralized nodule formation assessed by Alizarin Red staining. Commercially available silicate-based materials considered in the present review can potentially induce mineralization and odontogenic/osteogenic differentiation of hSCAPs, thus prompting their use in regenerative endodontic procedures.
PubMed: 32098171
DOI: 10.3390/ma13040974 -
European Journal of Orthodontics Nov 2020Superimposition of three-dimensional (3D) digital models offers great opportunities to assess tooth movement during time. In the literature, several superimposition...
BACKGROUND
Superimposition of three-dimensional (3D) digital models offers great opportunities to assess tooth movement during time. In the literature, several superimposition techniques are described.
OBJECTIVES
To summarize and critically assess the available evidence from studies on serial digital 3D dental model superimposition.
SEARCH METHODS
MEDLINE via Ovid and PubMed, EMBASE via Ovid, Cochrane Register of Diagnostic Test Accuracy Studies, and Google Scholar were searched with no time limit (last update: December 2018). Hand and unpublished literature searches were also performed.
SELECTION CRITERIA
Studies of any design that had a sample size ≥5 and tested superimposition of serial 3D digital dental models to assess tooth movement were included.
DATA COLLECTION AND ANALYSIS
Study selection, data extraction, and risk of bias assessment were performed independently by the authors.
RESULTS
Twelve studies met the eligibility criteria. The total risk of bias (QUADAS-2 tool) of 10 studies was high, whereas only 2 studies had unclear bias. Ten studies had high and two studies low overall applicability concerns. From these, one study tested the mandibular alveolar bone area, three studies the rugae area, nine studies a larger palatal area, and two studies the incisive papilla area. The high heterogeneity in samples, outcomes, and methods did not allow for synthesis of a considerable amount of studies in any case.
LIMITATIONS
The high heterogeneity among studies and the limited evidence did not allow for solid conclusions.
CONCLUSIONS AND IMPLICATIONS
The following areas of the maxilla could provide reliable outcomes: (1) the medial two-thirds of the third rugae and the area 5 mm dorsal to them and (2) an area including all rugae, with the lateral margins located at least 5 mm from the gingival margins and a distal margin that does not extend beyond the first molars. No recommendation is possible for other regions of the mouth. There is an urgent need for further research in the field.
REGISTRATION
PROSPERO (CRD42019124365).
Topics: Humans; Mandible; Maxilla; Molar; Palate; Tooth Movement Techniques
PubMed: 31742598
DOI: 10.1093/ejo/cjz075 -
Journal of Periodontology Dec 2018The efficacy of Coronally Advance Flap (CAF) has been extensively evaluated and several parameters influencing the results, such as interproximal attachment loss,... (Review)
Review
BACKGROUND
The efficacy of Coronally Advance Flap (CAF) has been extensively evaluated and several parameters influencing the results, such as interproximal attachment loss, recession defect size, papilla dimension, flap thickness, have also been identified. However, the influence of tooth location has not been systematically investigated yet. Therefore, the aim of this systematic review was to evaluate the influence of tooth location on the outcomes of CAF.
METHODS
A literature search on PubMed, EMBASE, Cochrane libraries and hand-searched journal until September 2017 was performed to identify clinical studies reporting the outcome of CAF for localized gingival recessions (GRs) for each single tooth.
RESULTS
Eighteen articles reporting 399 localized GRs treated with CAF were included in the present systematic review. Canines and incisors were related to a higher mRC and CRC than premolars and molars (odds ratio 1.63) (p < 0.05), while the right side showed a higher CRC than the left side (odds ratio 1.60) (p < 0.05). No differences were found between maxillary and mandibular dentition (p > 0.05). The addition of a graft such as Connective Tissue Graft (CTG) with or without Enamel Matrix Derivative (EMD) was shown to enhance the outcomes compared to CAF alone (p < 0.05). CRC was negatively affected by initial clinical attachment level (p < 0.05), but not from the initial recession depth (p > 0.05).
CONCLUSIONS
Tooth location plays an important role on mRC and CRC following CAF. The addition of CTG or substitutes, especially with biological agents (EMD), enhance the clinical outcomes compared to CAF alone.
Topics: Connective Tissue; Dental Enamel Proteins; Gingiva; Gingival Recession; Humans; Surgical Flaps; Tooth Root; Treatment Outcome
PubMed: 29963707
DOI: 10.1002/JPER.18-0201 -
International Journal of Dentistry 2018To identify whether there is a relationship between different implant shoulder positions/orientations/designs and prosthetic and/or implant failures, biological or... (Review)
Review
OBJECTIVES
To identify whether there is a relationship between different implant shoulder positions/orientations/designs and prosthetic and/or implant failures, biological or mechanical complications, radiographic marginal bone loss (MBL), peri-implant buccal recession (RC), aesthetic scores (Papilla Index, PES, and WES), and patient satisfaction after a minimum of 1 year function in the aesthetic zone, compared to the two-piece, conventional implant neck architecture.
MATERIALS AND METHODS
The systematic review was written according to the PRISMA guidelines. The search strategy encompassed the English literature from 1967 to September 2016 and was performed online (in the PubMed database of the U.S. National Library of Medicine, Embase, and the Cochrane Library) to identify relevant studies that met the inclusion criteria. The assessment of quality and risk of bias of the selected manuscripts was performed according to the guidelines provided by CONSORT and STROBE statements.
RESULTS
A total of 16 articles (7 randomized controlled trials, 4 observational comparative studies, and 5 systematic reviews) were selected to fulfill the inclusion criteria. A trend of higher implant failure and prosthetic complications were experienced in the one-piece group compared to the two-piece group, although no statistically significant differences were found. Higher marginal bone loss was found in the test group (one-piece, scalloped implants) compared to the control group (two-piece, flat implants). No comparative studies reporting data on sloped implants were found that fulfilled the inclusion and exclusion criteria of this systematic review. No differences were experienced between groups regarding aesthetic outcomes and patient satisfaction.
CONCLUSIONS
There was sufficient evidence that different implant shoulder positions/orientations/designs (scalloped, sloped, and one piece) offer no benefit when compared to two-piece, conventional flat implants. Current evidence is limited due to the quality of available studies.
PubMed: 29853895
DOI: 10.1155/2018/6812875 -
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 -
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 -
The Cochrane Database of Systematic... Oct 2016When primary root canal therapy fails, periapical lesions can be retreated with or without surgery. Root canal retreatment is a non-surgical procedure that involves... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
When primary root canal therapy fails, periapical lesions can be retreated with or without surgery. Root canal retreatment is a non-surgical procedure that involves removal of root canal filling materials from the tooth, followed by cleaning, shaping and obturating of the canals. Root-end resection is a surgical procedure that involves exposure of the periapical lesion through an osteotomy, surgical removal of the lesion, removal of part of the root-end tip, disinfection and, commonly, retrograde sealing or filling of the apical portion of the remaining root canal. This review updates one published in 2008.
OBJECTIVES
To assess effects of surgical and non-surgical therapy for retreatment of teeth with apical periodontitis.To assess effects of surgical root-end resection under various conditions, for example, when different materials, devices or techniques are used.
SEARCH METHODS
We searched the following electronic databases: the Cochrane Oral Health Trials Register (to 10 February 2016), the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1), MEDLINE Ovid (1946 to 10 February 2016) and Embase Ovid (1980 to 10 February 2016). We searched the US National Registry of Clinical Trials (ClinicalTrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials (to 10 February 2016). We placed no restrictions regarding language and publication date. We handsearched the reference lists of the studies retrieved and key journals in the field of endodontics.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) involving people with periapical pathosis. Studies could compare surgery versus non-surgical treatment or could compare different types of surgery. Outcome measures were healing of the periapical lesion assessed after one-year follow-up or longer; postoperative pain and discomfort; and adverse effects such as tooth loss, mobility, soft tissue recession, abscess, infection, neurological damage or loss of root sealing material evaluated through radiographs.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data from included studies and assessed their risk of bias. We contacted study authors to obtain missing information. We combined results of trials assessing comparable outcomes using the fixed-effect model, with risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, and 95% confidence intervals (CIs). We used generic inverse variance for split-mouth studies.
MAIN RESULTS
We included 20 RCTs. Two trials at high risk of bias assessed surgery versus a non-surgical approach: root-end resection with root-end filling versus root canal retreatment. The other 18 trials evaluated different surgical protocols: cone beam computed tomography (CBCT) versus periapical radiography for preoperative assessment (one study at high risk of bias); antibiotic prophylaxis versus placebo (one study at unclear risk); different magnification devices (loupes, surgical microscope, endoscope) (two studies at high risk); types of incision (papilla base incision, sulcular incision) (one study at high risk and one at unclear risk); ultrasonic devices versus handpiece burs (one study at high risk); types of root-end filling material (glass ionomer cement, amalgam, intermediate restorative material (IRM), mineral trioxide aggregate (MTA), gutta-percha (GP), super-ethoxy benzoic acid (EBA)) (five studies at high risk of bias, one at unclear risk and one at low risk); grafting versus no grafting (three studies at high risk and one at unclear risk); and low energy level laser therapy versus placebo (irradiation without laser activation) versus control (no use of the laser device) (one study at high risk).There was no clear evidence of superiority of the surgical or non-surgical approach for healing at one-year follow-up (RR 1.15, 95% CI 0.97 to 1.35; two RCTs, 126 participants) or at four- or 10-year follow-up (one RCT, 82 to 95 participants), although the evidence is very low quality. More participants in the surgically treated group reported pain in the first week after treatment (RR 3.34, 95% CI 2.05 to 5.43; one RCT, 87 participants; low quality evidence).In terms of surgical protocols, there was some inconclusive evidence that ultrasonic devices for root-end preparation may improve healing one year after retreatment, when compared with the traditional bur (RR 1.14, 95% CI 1.00 to 1.30; one RCT, 290 participants; low quality evidence).There was evidence of better healing when root-ends were filled with MTA than when they were treated by smoothing of orthograde GP root filling, after one-year follow-up (RR 1.60, 95% CI 1.14 to 2.24; one RCT, 46 participants; low quality evidence).There was no evidence that using CBCT rather than radiography for preoperative evaluation was advantageous for healing (RR 1.02, 95% CI 0.70 to 1.47; one RCT, 39 participants; very low quality evidence), nor that any magnification device affected healing more than any other (loupes versus endoscope at one year: RR 1.05, 95% CI 0.92 to 1.20; microscope versus endoscope at two years: RR 1.01, 95% CI 0.89 to 1.15; one RCT, 70 participants, low quality evidence).There was no evidence that antibiotic prophylaxis reduced incidence of postoperative infection (RR 0.49, 95% CI 0.09 to 2.64; one RCT, 250 participants; low quality evidence).There was some evidence that using a papilla base incision (PBI) may be beneficial for preservation of the interdental papilla compared with complete papilla mobilisation (one RCT (split-mouth), 12 participants/24 sites; very low quality evidence). There was no evidence of less pain in the PBI group at day 1 post surgery (one RCT, 38 participants; very low quality evidence).There was evidence that adjunctive use of a gel of plasma rich in growth factors reduced postoperative pain compared with no grafting (measured on visual analogue scale: one day postoperative MD -51.60 mm, 95% CI -63.43 to -39.77; one RCT, 36 participants; low quality evidence).There was no evidence that use of low energy level laser therapy (LLLT) prevented postoperative pain (very low quality evidence).
AUTHORS' CONCLUSIONS
Available evidence does not provide clinicians with reliable guidelines for treating periapical lesions. Further research is necessary to understand the effects of surgical versus non-surgical approaches, and to determine which surgical procedures provide the best results for periapical lesion healing and postoperative quality of life. Future studies should use standardised techniques and success criteria, precisely defined outcomes and the participant as the unit of analysis.
Topics: Humans; Periapical Periodontitis; Randomized Controlled Trials as Topic; Retreatment; Root Canal Therapy
PubMed: 27759881
DOI: 10.1002/14651858.CD005511.pub3 -
The International Journal of Oral &... 2014To test whether or not immediate loading of single-implant crowns renders different results from early and conventional loading with respect to implant survival,... (Meta-Analysis)
Meta-Analysis
PURPOSE
To test whether or not immediate loading of single-implant crowns renders different results from early and conventional loading with respect to implant survival, marginal bone loss, stability of peri-implant soft tissue, esthetics, and patient satisfaction.
MATERIALS AND METHODS
An electronic search of Medline and Embase databases including studies published prior to August 1, 2012, was performed and complemented by a manual search. Randomized controlled trials (RCTs) comparing different loading protocols of single-implant crowns with a follow-up after restoration of at least 1 year were included. A meta-analysis yielded odds ratios (OR) and standardized mean differences (SMD) together with the corresponding 95% confidence intervals (95% CI).
RESULTS
The search provided 10 RCTs comparing immediate and conventional loading and 1 RCT comparing immediate and early loading. When assessing the implant survival at 1 year of loading, the meta-analysis of 10 studies found no significant differences between immediate and conventional loading (OR = 0.75; 95% CI: 0.32 to 1.76). The total difference of marginal bone loss during the first year of function between immediate and conventional loading protocols in 7 RCTs did not reach statistical significance (SMD = -0.05 mm; 95% CI: -0.41 to 0.31 mm). There were no significant differences between immediate and conventional loading regarding implant survival and marginal bone loss at 2, 3, and 5 years of loading. Three RCTs comparing the change of papilla level between immediate and conventional loading identified no significant differences. One study investigated the recession of the buccal mucosa after implant placement and found significantly inferior soft tissue loss for immediate loading as compared to conventional loading. Two RCTs investigated the recession of the buccal mucosa after insertion of the definitive crown and found no differences between immediate and conventional loading. The esthetics and the patient satisfaction were assessed in one and two RCTs, respectively. There were no significant differences between immediate and conventional loading.
CONCLUSIONS
Immediately and conventionally loaded single-implant crowns are equally successful regarding implant survival and marginal bone loss. This conclusion is primarily derived from studies evaluating implants inserted with a torque ≥ 20 to 45 Ncm or an implant stability quotient (ISQ) ≥ 60 to 65 and with no need for simultaneous bone augmentation. Immediately and conventionally loaded implants do not appear to differently affect the papilla height during the first year of loading. Due to the heterogeneity of the time point of baseline measurements and contradictory findings in the studies, it is difficult to draw clear conclusions regarding the recession of the buccal mucosa. With respect to the assessment of esthetic outcomes and patient satisfaction, the data available remain inconclusive.
Topics: Female; Humans; Middle Aged; Alveolar Bone Loss; Bone Density; Crowns; Dental Implantation, Endosseous; Dental Implants, Single-Tooth; Dental Restoration Failure; Gingival Recession; Immediate Dental Implant Loading; Mandible; Maxilla; Patient Satisfaction; Randomized Controlled Trials as Topic; Time Factors; Torque
PubMed: 24660200
DOI: 10.11607/jomi.2014suppl.g4.1 -
Journal of Clinical Periodontology Apr 2014To review the dental literature in terms of efficacy of soft tissue augmentation procedures around dental implants and in partially edentulous sites. (Review)
Review
AIM
To review the dental literature in terms of efficacy of soft tissue augmentation procedures around dental implants and in partially edentulous sites.
METHODS
A Medline search was performed for human studies augmenting keratinized mucosa (KM) and soft tissue volume around implants and in partially edentulous areas. Due to heterogeneity in between the studies, no meta-analyses could be performed.
RESULTS
Nine (KM) and eleven (volume) studies met the inclusion criteria. An apically positioned flap/vestibuloplasty (APF/V) plus a graft material [free gingival graft (FGG)/subepithelial connective tissue graft (SCTG)/collagen matrix (CM)] resulted in an increase of keratinized tissue (1.4-3.3 mm). Statistically significantly better outcomes were obtained for APF/V plus FGG/SCTG compared with controls (APF/V alone; no treatment) (p < 0.05). For surgery time and patient morbidity, statistically significantly more favourable outcomes were reported for CM compared to SCTGs (p < 0.05) in two randomized controlled clinical trials (RCTs), even though rendering less keratinized tissue. SCTGs were the best-documented method for gain of soft tissue volume at implant sites and partially edentulous sites. Aesthetically at immediate implant sites, better papilla fill and higher marginal mucosal levels were obtained using SCTGs compared to non-grafted sites.
CONCLUSIONS
An APF/V plus FGG/SCTG was the best-documented and most successful method to increase the width of KM. APF/V plus CM demonstrated less gain in KM, but also less patient morbidity and surgery time compared to APF/V plus SCTG based on two RCTs. Autogenous grafts (SCTG) rendered an increase in soft tissue thickness and better aesthetics compared to non-grafted sites.
Topics: Collagen; Connective Tissue; Dental Implants; Gingiva; Gingivoplasty; Humans; Jaw, Edentulous, Partially; Periodontal Diseases; Periodontium; Surgical Flaps; Treatment Outcome; Vestibuloplasty
PubMed: 24641003
DOI: 10.1111/jcpe.12220