Evaluation of marginal bone level, technical and biological complications between screw-retained and cement-retained all-ceramic implant-supported crowns on zirconia abutment: A systematic review and meta-analysis.

PURPOSE: The purpose of this study was to evaluate the difference in marginal bone level, technical and biological complications between screw-retained and cemented all-ceramic implant-supported crowns fabricated on zirconia abutment at different follow-up periods. MATERIALS AND METHODS: Independent search was conducted in Cochrane Library, EBSCO, and PubMed/PubMed Central/MEDLINE databases and the Google Scholar search engine for prospective studies and randomized controlled trials published between January 2014 and June 2023 evaluating the marginal bone level, technical and biological complications between screw-retained and cemented all-ceramic implant-supported crowns fabricated on zirconia abutment. Meta-analysis was conducted to assess the quantitative data on the marginal bone level and biological complications. RESULTS: A total of eight studies were included for qualitative synthesis and six studies for quantitative synthesis. For marginal bone level, no statistically significant difference was observed (P = 0.83 and P = 0.69, respectively) during the follow-up period of 3 years and 5 years. For probing depth, the cemented group showed more amount of probing depth than the screw-retained group at a follow-up period of 3 years (P < 0.05) whereas no statistically significant difference was observed at a follow-up period of 5 years (P = 0.73). For bleeding on probing, the cemented group showed more probing depth than the screw-retained group at a follow-up period of 5 years (P = 0.10). CONCLUSION: The evidence suggests that the screw-retained group showed no statistically significant difference in marginal bone level, comparatively fewer biological complications, and relatively higher technical complications than the cemented group at different follow-up periods.

A systematic review and meta-analysis of accuracy between protrusive interocclusal record and horizontal condylar guidance angle recording methods in dentulous patients.

AIM: This systematic review and meta-analysis aimed to evaluate the accuracy of different methods used for measuring horizontal condylar guidance (HCG) angle in comparison with protrusive interocclusal record (IOR) for dentulous patients. SETTINGS AND DESIGN: The design involves systematic review and meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. MATERIALS AND METHODS: An electronic search was carried out by two reviewers in the Google Scholar search engine and the EBSCO host, Cochrane Library, and PubMed/MEDLINE databases for quasi-experimental studies, in vivo studies, and cross-sectional studies published from January 2005 to February 2023 determining the HCG angle in dentulous patients. STATISTICAL ANALYSIS USED: Meta-analysis was performed to evaluate the quantitative data. RESULTS: A total of 577 articles were identified, 29 analytical cross-sectional studies that fulfilled the eligibility criteria were included for qualitative synthesis and 26 studies were included for meta-analysis. A statistically significant difference was observed for the right and left HCG angles obtained by the panoramic radiograph method and cone-beam computed tomography (CBCT) method and for the right side HCG angle obtained by cephalogram method showing higher values than the protrusive IOR method. No statistically significant difference was observed for the left side HCG angle obtained by the cephalogram method and both the right and left side HCG angles obtained by the intraoral tracer method. CONCLUSIONS: The panoramic radiograph, cephalogram, and CBCT obtained higher HCG angles in dentulous patients than the protrusive IOR method.

Evaluation of accuracy between extraoral Gothic arch tracing and various other methods assessing horizontal condylar guidance angle in completely edentulous patients: A systematic review and meta-analysis.

Aim: The aim of this systematic review and meta-analysis was to determine the accuracy of different methods of measuring horizontal condylar guidance (HCG) angle in comparison with extraoral Gothic arch tracing for completely edentulous patients. Settings and Design: This was a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Materials and Methods: Two reviewers searched the EBSCOhost, Cochrane Library, and PubMed/MEDLINE databases and the Google Scholar search engine for in vivo studies, randomized controlled trials, cross-sectional studies, and quasi-experimental studies published from January 2005 to December 2022 on various other methods of determining HCG angle in completely edentulous patients compared with extraoral Gothic arch tracing method. Statistical Analysis Used: Meta-analysis was conducted from the reported quantitative data. Results: A total of 513 articles were obtained from different electronic databases, of which 22 studies were included for qualitative synthesis and 20 studies were included for meta-analysis. For the right side, a statistically significant difference was observed for panoramic radiograph (P < 0.05, pooled mean difference = 5.08 [2.17, 7]) and cephalogram (P < 0.05, pooled mean difference = 10.65 [8.81, 12.49]), whereas no statistically significant difference was observed for cone-beam computed tomography (CBCT) (P = 0.41, pooled mean difference = 4.39 [-6.10, 14.87]) and protrusive interocclusal wax record (P = 0.92, pooled mean difference = -0.45 [-9.62, 8.72]) as compared with extraoral Gothic arch tracing method. For the left side, a statistically significant difference was observed for panoramic radiograph (P < 0.05, pooled mean difference = 5.07 [1.95, 8.18]) and cephalogram (P < 0.05, pooled mean difference = 10.24 [8.65, 11.83]), whereas no statistically significant difference was observed for CBCT (P = 0.31, pooled mean difference = 4.05 [-3.74, 11.84]) and protrusive interocclusal wax record (P = 0.72, pooled mean difference = -1.21 [-7.86, 5.43]) as compared with extraoral Gothic arch tracing method. Conclusion: The cephalogram and panoramic radiograph obtained higher HCG angles in completely edentulous patients than extraoral Gothic arch tracing.

Evaluation of implant stability and increase in bone height in indirect sinus lift done with the osseodensification and osteotome technique: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Whether the use of osseodensification burs for indirect sinus lift improves primary implant stability and bone height as compared with the osteotome technique to overcome the challenges of the pneumatization of the maxillary sinus and vertical bone loss after extraction in the edentulous posterior maxilla is unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the difference in primary implant stability and increase in bone height in indirect sinus lift using osseodensification and the osteotome technique. MATERIAL AND METHODS: Two independent reviewers searched the MEDLINE/PubMed, EBSCO, and Cochrane Library databases and the Google Scholar Search engine for randomized clinical trials, nonrandomized clinical trials, and cross-sectional studies published from 2000 to 2022 to identify relevant studies evaluating the primary implant stability and increase in bone height in indirect sinus lift using osseodensification and the osteotome technique. A meta-analysis was performed to evaluate the cumulative data on primary implant stability and increase in bone height. RESULTS: A total of 8521 titles were obtained by electronic database search, of which 75 were duplicates. A total of 8446 abstracts were screened, and 8411 that were not relevant to the topic were excluded. Thirty-five articles were eligible for full-text assessment. After the screening of full-text articles as per the selection criteria, 26 studies were excluded. For qualitative synthesis, 9 studies were included. For quantitative synthesis, 5 studies were included. For an increase in bone height, no statistically significant difference was observed (I2 = 89%, P=.15, pooled mean difference=0.30 [-0.11, 0.70], CI=95%). For primary implant stability, the osseodensification group showed higher values than the osteotome group (I2 = 20%, P<.001, pooled mean difference=10.61 [7.14, 14.08], CI=95%). CONCLUSIONS: The evidence obtained from quantitative analysis of the studies determined that the osseodensification group showed higher primary implant stability than the osteotome group (P<.05). However, for mean increase in bone height, there was no statistically significant difference between the groups.

Diagnostic accuracy of ultrasonography compared with magnetic resonance imaging in diagnosing disc displacement of the temporomandibular joint: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Diagnosing temporomandibular disorders without an adjunctive chairside diagnostic tool has made the management of temporomandibular disorders challenging and subjective. The use of magnetic resonance imaging, considered the standard imaging modality, is hindered because of high cost, a long learning curve, availability, and a longer examination time. PURPOSE: The purpose of this systematic review and meta-analysis was to determine whether ultrasonography could be a chairside tool to help clinicians diagnose disc displacement in temporomandibular disorders. MATERIAL AND METHODS: An electronic search was conducted of the PubMed (including MEDLINE) and Cochrane Central database and the Google Scholar search engine for articles published from January 2000 to July 2020. Studies were chosen based on the inclusion criteria, which included the diagnostic technique's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with respect to imaging the displacement of the articular disc. The quality assessment of diagnostic accuracy studies (QUADAS- 2) tool was applied to assess the risk of bias for the included studies. The Meta-Disc 1.4 and RevMan 5.3 software program were used to conduct the meta-analysis. RESULTS: Seventeen articles were included in this systematic review, and a meta-analysis of 14 articles was done after applying the inclusion and exclusion criteria. None of the included articles were considered to have applicability concerns; however, 2 articles had a high risk of bias. The sensitivities and specificities for the different selected studies vary substantially from 21% to 95% with a good pooled sensitivity estimate of 71% while the specificities varied from 15% to 96% with a good pooled specificity estimate of 76%. CONCLUSIONS: This systematic review and meta-analysis suggested that ultrasonography may have clinically acceptable diagnostic accuracy in diagnosing disc displacement of the temporomandibular joint, allowing the treatment of patients with temporomandibular disorders with greater assurance and success. Additional training in the operation and interpretation of ultrasonography is required to reduce the learning curve and make the use of ultrasonography relevant, straightforward, and routine in dentistry to supplement clinical examination and diagnosis in patients with suspected disc displacement of the temporomandibular joint. The evidence acquired needs to be standardized, and further research is required to provide stronger evidence.

An Overview of Systematic Reviews and Meta-analyses Evaluating Different Impression Techniques for Implant-Supported Prostheses in Partially and Completely Edentulous Arches.

PURPOSE: To summarize the evidence and determine the most effective impression technique for implant-supported prostheses in terms of accuracy, time efficiency, and patient preference in partially and completely edentulous arches. MATERIALS AND METHODS: The searches were performed independently up to April 30, 2021 by two review authors through the Cochrane Oral Health Review, MEDLINE/PubMed, LILACS, and Science Direct databases. Moreover, manual and gray literature searches were performed to identify further potential reviews. Only English language-based systematic reviews with and without meta-analyses evaluating the different dental implant impression techniques were included. The outcomes assessed were accuracy, time efficiency, and patient preference. The methodologic quality of the included reviews was investigated by using the R-AMSTAR tool, and the degree of overlap of primary studies was assessed by calculating the percentage of corrected covered area (CCA) as proposed by Pieper et al.64 Results: The qualitative analysis included a total of 28 reviews, 8 of which included meta-analyses, published between 2008 and 2021, involving a total of 42 clinical trials and 203 laboratory studies. Digital vs conventional implant impression techniques were compared in 17 reviews, different digital impressions in 3 reviews, and different conventional impression techniques in the remaining reviews. Overall, the methodologic quality assessed by using the R-AMSTAR tool was moderate (mean: 26.7 ± 5.5) with slight overlap of primary studies (CCA; 5.23%). CONCLUSION: Within an overall moderate methodologic quality, the digital implant impressions showed favorable outcomes in terms of accuracy, time efficiency, and patient preference in partially edentulous arches involving three or fewer implants. However, the accuracy of full-arch digital impressions involving multiple implants is not satisfactory and needs significant improvements. Hence, future studies following stringent guidelines and robust methodology are recommended to substantiate the findings of this overview and provide a high level of evidence.

Histologic Assessment of Peri-implant Tissues Around Endosseous Dental Implants Placed Along with Intentionally Retained Root Fragment in Animal Models: A Systematic Review.

PURPOSE: To evaluate whether the placement of endosseous dental implants along with intentionally retained root fragments enhances peri-implant histologic characteristics and outcomes in healthy animal models. MATERIALS AND METHODS: Two review authors independently performed electronic literature searches across the PubMed/MEDLINE, LILACS, EBSCOhost, and Science Direct databases by using different keywords and Medical Subject Headings terms to identify relevant articles. Only preclinical animal trials evaluating the histology of peri-implant tissues around endosseous dental implants placed along with intentionally retained root fragments were included in the review. The risk of bias assessment was investigated using the Systematic Review Centre for Laboratory animal Experimentation (SYRCLE) tool, and the reporting quality of each trial was evaluated using the Animal Research: Reporting in Vivo Experiments guidelines. RESULTS: Seven preclinical trials including a total of 33 animals and 155 endosseous dental implants were eligible for the analysis. One trial reported the histologic assessment of peri-implant tissues around endosseous dental implants with ankylotic root fragments, whereas the other six studies used nonankylotic root fragments. The effects of the length of retained root fragments on peri-implant tissues were reported in two trials that showed contrasting results. The effects of the width of retained root fragments were assessed in two trials reporting that a remaining thickness < 2 mm and buccal bone thickness > 3 mm favors alveolar bone preservation over a period of 12 weeks. Although the mean quality assessment score for all preclinical trials was moderately high, the summary for the risk of bias presented a high risk. CONCLUSION: Limited data and short-term preclinical evidence showed optimal peri-implant histologic findings of endosseous dental implants placed along with intentionally retained root fragments. However, further preclinical histologic evaluation with homogenous populations and long-term controlled clinical studies are needed to substantiate its applicability in clinical situations.

Overview of Systematic Reviews and Meta-analyses Investigating the Efficacy of Different Nonsurgical Therapies for the Treatment of Peri-implant Diseases.

PURPOSE: To summarize the methodologic quality and outcome measures from systematic reviews and meta-analyses evaluating the efficacy of different nonsurgical therapies for the treatment of peri-implant diseases. MATERIALS AND METHODS: Two review authors independently searched for systematic reviews and meta-analyses evaluating the efficacy of different nonsurgical therapies for treatment of peri-implant diseases in three different databases: MEDLINE, Embase, and the Cochrane Library. In addition, journals with a high impact factor in the fields of periodontics, prosthodontics, oral maxillofacial surgery, and implant dentistry were analyzed for potential reviews. The search was implemented from January 2010 through August 2020. Eligible reviews were screened and assessed to determine the characteristics and outcome measures. Furthermore, two review authors independently evaluated the methodologic quality by using the AMSTAR tool and the checklist proposed by Glenny et al. The interrater agreement was assessed by using the Cohen kappa coefficient. The assessment of correlation between the findings of the AMSTAR tool and Glenny et al checklist was performed by using the Spearman correlation. RESULTS: Fifteen systematic reviews and 12 meta-analyses were evaluated based on the inclusion criteria. One review investigated the efficacy of growth factors and another investigated glycine powder air polishing, 5 evaluated the role of antimicrobial photodynamic therapy, 8 assessed the effect of laser therapy, and 13 compared the different nonsurgical therapies with the surgical therapies for the treatment of peri-implant diseases. The quality assessment score evaluated by the AMSTAR checklist ranged from 5 to 11 with a mean of 7.5 ± 1.8, whereas the score evaluated by the Glenny et al checklist ranged from 3 to 14 with a mean of 9.7 ± 2.8. Spearman correlation analysis between these two tools reported a high correlation (r = 0.91) that was statistically significant (P < .001). CONCLUSION: The summarized evidence of this overview shows that the different nonsurgical therapies are effective for the treatment of peri-implant mucositis. The lack of sufficient long-term data involving large datasets results in their inconclusive efficacy in the treatment of peri-implantitis. However, the summary is determined from the moderate quality of evidence. Hence, future well-designed high-quality trials are encouraged to reassess the findings.

Biomechanical and histomorphometric analysis of endosteal implants placed by using the osseodensification technique in animal models: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Osseodensification, a counterclockwise drilling technique for the placement of endosseous implants is a popular clinical technique. However, the effect of the osseodensification technique on primary implant stability, bone-implant contact, and bone area frequency occupancy is unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to investigate the biomechanical and histomorphometric outcomes of endosteal implants placed by using the osseodensification technique in animal models. MATERIAL AND METHODS: An electronic search through Medline/PubMed, Lilacs, and Science Direct databases, and an additional manual search of the reference list of included articles was conducted by using specific keywords and Medical Subject Headings (MeSH) terms for articles in the English language and published up to April 31, 2020. Only animal studies comparing the biomechanical and histomorphometric outcomes of endosteal implants placed by using the osseodensification and conventional drilling protocol were included. The SYstematic Review Center for Laboratory animal Experimentation (SYRCLE) tool was used to determine the risk of bias assessment, and the quality of included studies was assessed by using Animal Research: Reporting in Vivo Experiments (ARRIVE) guidelines. RESULTS: Nine studies were included. The results of the meta-analysis showed that the pooled weighted mean difference of the insertion torque value for the primary implant stability of endosseous dental implants placed by using the osseodensification technique was 2.270 (95% confidence interval [CI]=1.147 to 3.393; P<.001), the weighted mean difference of the percentage of bone-implant contact at 3 weeks was 0.487 (95% CI=0.220 to 0.754; P=.114), the weighted mean difference of the percentage of bone-implant contact at 6 weeks was 0.565 (95% CI=0.219 to 0.911; P=.448), the weighted mean difference of the percentage of bone area frequency occupancy at 3 weeks was 0.679 (95% CI=0.265 to 1.093; P=.073), and the weighted mean difference of the percentage of bone area frequency occupancy at 6 weeks was 0.391 (95% CI=-0.204 to 0.986; P=.027). CONCLUSIONS: Limited data from animal studies suggest that the primary implant stability, bone-implant contact, and bone area frequency occupancy significantly improved for the endosteal implants placed by using the osseodensification technique compared with conventional drilling protocol. However, additional laboratory and clinical studies are recommended to provide stronger evidence.

Autogenous bone ring for vertical bone augmentation procedure with simultaneous implant placement: A systematic review of histologic and histomorphometric outcomes in animal studies.

STATEMENT OF PROBLEM: The performance of the autogenous bone ring (ABR) technique used for the vertical bone augmentation procedure has not yet been determined. PURPOSE: The purpose of this systematic review was to investigate whether the ABR technique for the vertical bone augmentation procedure with simultaneous implant placement enhances the histologic and histomorphometric outcomes in surgically created bone defects in animal models. MATERIAL AND METHODS: An electronic search of 3 databases, Medline/PubMed, Science Direct, Lilacs, and a manual search of a reference list of relevant studies were performed. Only animal studies regarding vertical bone augmentation by using the ABR technique with simultaneous implant placement in surgically created bone defects were included in the review. The SYstematic Review Center for Laboratory Animal Experimentation tool was used to determine the risk of bias assessment, and the quality of included studies was assessed by using the Animal Research: Reporting in Vivo Experiments guidelines. RESULTS: Five studies were included in the qualitative analysis based on the inclusion and exclusion criteria. One study comparing the ABR technique with the bovine and biphasic ring reported a high percentage of bone area and bone implant contact of the ABR at 5 weeks of osseointegration. Similar histologic findings were reported in another study at 4 months of healing, but contrasting data were reported at 8 months. Another study reported an increase in the percentage of bone area and bone implant contact of the ABR technique from 3 months to 6 months of osseointegration. Two studies reported an increase in the percentage of bone area, and 1 study reported a decrease in the mean of bone implant contact, both with simultaneous and staged implant procedures. CONCLUSION: Based on the limited available studies, the use of the ABR technique for the vertical bone augmentation procedure with simultaneous implant placement presented optimal histologic and histomorphometric outcomes in surgically created bone defects in animal models. However, the results of the current review are not sufficiently robust to support the use of the ABR technique for vertical bone augmentation in humans.

Microcomputed tomography a noninvasive method to evaluate the fit of a restoration as compared to conventional replica technique.

AIM: The aim of the study was to compare the assessment methods used to evaluate the fit of Ni-Cr metal copings. SETTINGS AND DESIGN: Comparative- Invitro study design. MATERIALS AND METHODS: A stainless steel die simulating a prepared first maxillary premolar was used as a master die. Wax pattern copings were fabricated by the conventional dipping wax technique (n = 20) on the master die and were cast in Ni-Cr alloy. The finished copings were fitted on the master die and scanned by the micro-computed tomography (CT) scanner. Multiple projections of the sample were reconstructed to evaluate the marginal and internal fit at 5 predetermined locations. The same copings were used for the replica technique and were evaluated under a stereomicroscope in the same locations. STATISTICAL ANALYSIS USED: Shapiro-Wilk's test and Unpaired t-test. RESULTS: The marginal fit values observed were 127.71 and 95.06 µm, chamfer area fit values were 151.97 and 132.7 µm, axial area fit values were 62.36 and 46.14 µm, axio-occlusal area fit values were 139.52 and 123.6 µm, occlusal area fit values were slightly higher with 217.91 and 193.1 µm, respectively, in replica and micro-CT technique. There was no statistically significant difference observed in the fit between the two assessment methods (α > 0.05). CONCLUSIONS: There was no difference observed in the marginal and internal fit of Ni-Cr metal copings with the two methods of assessment. However, the micro-CT technique proved to be simpler, noninvasive, and time-saving assessment method.

Comparative evaluation of the shear bond strength of adhesive and self-adhesive resin luting agents to three commercially available composite core build-up materials: An in vitro study.

AIM: The aim of the study was to evaluate the shear bond strength of adhesive and self-adhesive resin luting agents (RLAs) to three commercially available composite core build-up materials (CBMs). SETTINGS AND DESIGN: Comparative -invitro study. MATERIALS AND METHODS: Sixty samples, 20 each of self-cure (Incore, Medicept: Group I), light cure (Light-Core, Bisco: Group II), and dual cure (LuxaCore Z-Dual, DMG America: Group III) composite CBMs were made in the lower mold space of a customized stainless steel jig. They were further subdivided into subgroups A and B for bonding with the adhesive (RelyX Ultimate, 3M ESPE) and self-adhesive (RelyX Unicem, 3M ESPE) RLAs respectively. For specimens in subgroup A, the bonding agent (Scotchbond Universal Adhesive, 3M ESPE) was rubbed onto the surface for 20 s prior to bonding with the adhesive RLA. For specimens in subgroup B, no pretreatment of the surface was carried out. The CBM-luting agent sample was tested for the shear bond strength in a universal testing machine. STATISTICAL ANALYSIS USED: ANOVA, Tukey's multiple comparison, and independent t-test. RESULTS: Adhesive RLA showed the highest shear bond strength to light cured composite CBM. Self-adhesive RLA showed the highest shear bond strength to dual-cured composite CBM. Adhesive RLA showed higher shear bond strength to all three composite CBMs as compared to the self-adhesive luting agent. This difference was statistically significant for the self-cure and light cure composite CBMs. CONCLUSION: Adhesive RLA showed greater shear bond strengths to all the three groups of composite CBMs as compared to self-adhesive RLA.

Recreating first digit with silicone prosthesis.

The hand is an integral part of our body. Any deviation in hand anatomy not only affects the day-to-day function but it even results in unesthetic appearance. Rehabilitation of these deformities is done either by microsurgery or with the help of silicone prosthesis. Nonsurgical treatment was carried out, where rehabilitation of the first digit was done with customized silicone prosthesis. Replacement of these deformities with silicone prosthesis is usually done by prosthetist. However, we being an oral and maxillofacial prosthodontist, replacement of these missing complete or partial fingers, thumb, ear, and nose is also done by prosthodontist. Rehabilitation of these deformities with silicone prosthesis can offer psychological, functional, and esthetic advantages. Recent advances in materials and skill of an individual made it possible to fabricate esthetically pleasing prosthesis. Mini implants are widely used for retaining silicone prosthesis; however, they are expensive and need surgical intervention. Vacuum-retained silicone-retained silicone prosthesis is a good and minimal invasive option for these patients. This clinical report describes a straightforward technique for fabricating silicone thumb prosthesis for a patient with amputated thumb.